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Miscellaneous - 243 GREAT POND ROAD 4/30/2018
o h O o 4 � o o z 0 a o � o w U �M��� N � � I N I i --� � '`��. Date..... �.�r..: � TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. ,F�..i..�..P..'�. s d �x�/.e..r:........� ..................... ......................... has permission to perform .... -. . .......... ��.. �.7....., ......oex,. wiring in the building of................................................................ at......`.,.......�..`��..lY.....1..,NorthAndover ass. �V,'ee.... �............. Lic. NAt %.r. T� E ICAL INSPEC)' "C;heck # ComnwnureaUh o� /!/assachu�aW Official Use Onlyown j 1�a artnani o �� Permit No. P Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Vev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOII9 Gad•or Town of: /]/ A�AIDOdG k? By this application the undersigned gives notice of his or her intention to Location (Street & Number) --2 y3 C�.PG/�T ;"-,u Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes LP Purpose of Building a), �fiGLL/irtQ Date: , - 7ar - To the Inspector ojWires: :dorm the rJectrical work described below. Telephone No. No ❑ (Check Appropriate Boz) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters ( mmnletion of the followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans r o ota Transformers KVA No. pf Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above Swimming Pool E] In- nd. ❑ en i No. o Emergency ng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o election ad Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Po eat Pump Totals: Number ons o. o e ontain ed Detection/Alerting Devices I No. of Dishwashers Space/Area Heating KW MuniI Local ❑ Conneeh'aon ❑ Otber No. of Dryers ry Heating Appliances KW No. Systems:* No. of Devices or Equivalent No. of Water KW Heaters o. o o. of Signs Ballasts Data Wiring: No. of Devices or E uivalent t o. Hydromassage Bathtubs No. of Motors Total HP Telecommunications inng. No. of Devices or E uivalent OTHER: Attach additional detail if desire4 or as required by the Inspector of Wires. Estimated Value of EIectrical Work: (When required by municipal policy.) Work to Start:I_ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove a 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 andpenalties of perjury, that the information on this application is true and complete- FIRM ompleteFIRM NAME- v ' . LIC. NO.: Licensee: �'S ,,W s O Signature a LIC. O.: (7f applicable, enter "exempt" in the license number line) - Address: /°% ��L lie t4 ��'l�Q�t f �[1?l�f� � AMA 01,4,, a Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department oMblic Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ - U6 N M r The Commonwealth of Massachusetts Department of Industrial Accidents t I Congress Street, Suite 100 Boston, MA 02114-2017 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaus/Plumbers. To BE FILED WITH THE PERMITTING AUTHORITY. - Applicant Information Please Print LeLtbly Name (BosinmV0rganization,/Wivi&al): L�1G .h1� 8 0 � r2f i G 4 iii City/State/Zip: Pi7h�.lC/l� Are you as employer? Check the appropriate boa: Phone M a g— �F�- 1.0 1 am a employer with _Lf employees (full andfor Part-time)-* 201 am a sole proprietor or pa%uwfsrsbip and have m employees working for me in any capacity. [No workers' comp_ instnance tcquirtAl 3.01 am a bamenwner doing all wort mysclC [No workers' comp- insurance rcgx'rcd.l t 4.01 am a bomeawwr and will be hiring contractors to conduct all work on my property- 1 will ensue that all contractors either have workers' compensation instuancc or arc sok proprietors with no employees. 501 am. a general contractor and I have blued the sub -contractors listed on the attached sheet. These sub -contractors bave employees and have workers' comp. insurance -t 6.0 we ate a corporation end its offices have exercised their right of exemption per MGL c- 152, §11(4) god we have no employees. (No workers' comp. inwrance rogerired.l Type of project (required): 7. 0 New construction 8. p Remodeling 9. ❑ Demolition 10 0 Building addition 11.[§1lectrical repairs or additions 12. []Plumbing repairs or additions 13.0 Roof repairs 14.00ther *Any applicant that thetics box #1 must also 511 out the section below showing tbCv workers' compensationpolicy information. t Homcownes who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a oew affidavit indicating such. tCootractors that check this box mast attached an additional sheet showing the name of the sub -contractors and sate whether or not those entities have employees, if the subcontractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic.#: 1/l//�' _ 40®I �� Expiration Date: Job Site Address: 2.) (� AO, / % � � City/StaloZip: /yL „ %%2 dp ✓GiQ Ao- 69`ga Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration ofate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of 'u that the information provided above is true and correct Sivnature- C o Date: Phone N: f7,0— !:�-,"J%its ✓� Official use only. Do not write in this area, to be completed by city or town q, kW City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CityfTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #- Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING i . L e-le—VZOICJ1,01. rx —1, Thiscertifies that ��.......................','............................f................................................ has permission to perform .... .,� ...... l5k...... ....... wiring in the buildin of.......o ` { Lo............................................................................ at ......,,.. „"I: .& P �- � J.'. , North Andover, Mass. ...................................................................... Fee..,. ......... Lic. No. AZV .. .................................................................................. ELECTRICAL INSPECTOR Check # .�.� C.orxcmonu�eaClh. of f'�/a�aacyivaetLt •, ••'•"• •,�v .,..'' c� Permit No. - �.JeP,zr�oneact o��ire �ervice� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. /07] (leave blank) APPLICATION FOR PERMIT TO PERFORM! ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT' IN INK OR TYPE ALL INFORMATION) Date: � ' 2-0 Is City or Town of N(Y11h To the Inspector of Wires: By this application the undersigned gives nota e of his or her intention to perform the electrical work described below. Location (Street & Number) Ll '12) re,(_6 b4 Pry) Owner or "Tenant Ynt l v f,�> Telephone No. Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service New Service Yes ❑ No 0 (Check Appropriate Boa) Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ No, of Meters No. of Meters Number of feeders and Ampacity c Location and Nature of proposed Electrical Work: t �L OS lmQ�rr h_p� r Completion ofthe followin)z table may be waived by the Inspector oJI wires. I, . f Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $200.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no pem it for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofpeijuty, that the information on this application is true and complete. FIRIM NAME: DIPIETRO HEATING & COOLING -01 0}, g&C g IC. NO.:A18265 Licensee: ERIK PIERMATTEI Signature > �� LIC. NO.:40803E — (7f applicable, enter "exempt" in the license number line.) � Bus. Tel. No.: 978-372-4111 Address: 5 SOUTH SUMMER ST BRADFORD MA 01835 Alt. Tel. No.: 978-994-0725 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic_ No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone 1110. I 4,v) ✓O . lkk` p� Y f Total No. of Recessed Luminaires p- (Paddle)formers No. of Cell. -Sus addle Fans4No. KVA No. of Luminaire Outlets No. of Bot Tubs ators KVA No. of Luminaires Above far- Swimming fool rnd ❑ 6rn Emergency Lighting Battery Units No. of Receptacle Outlets No_ of Oil Burners FIREALARMS No. of Zones Detection and No. of Switches No. of Gas Burners itiatin Devices Ranges No. of Ran es No. of Air Cond. Totalo.o No. Alerting Devices Meat Puanp Number Tons KW No. of Self -Contained No. of Waste Disposers Totals: I IDetection/Alerting Devices No. of Dishwashers Space/Area Beating KW Local ❑Municipal ❑ Other Connection No. of Dryers r3' Ideating Appliances KW Security Systems:*' No_ of Devices or E uivalent No. of Water KW No_ of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or quivalent No. Hydromassage Bathtubs No. of Motors 'Total BP Telecommunications Wirinv: No. of Devices or E uiv5ent I, . f Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $200.00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no pem it for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofpeijuty, that the information on this application is true and complete. FIRIM NAME: DIPIETRO HEATING & COOLING -01 0}, g&C g IC. NO.:A18265 Licensee: ERIK PIERMATTEI Signature > �� LIC. NO.:40803E — (7f applicable, enter "exempt" in the license number line.) � Bus. Tel. No.: 978-372-4111 Address: 5 SOUTH SUMMER ST BRADFORD MA 01835 Alt. Tel. No.: 978-994-0725 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic_ No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone 1110. I 4,v) ✓O . lkk` p� Y 1GENSE NU.MB�R EXPIRATION DATE SERIAL IUUMt3 R__ -suolleln6ai Jo/pue Mel !q paalnbaa se palsod ao uos.ied anoA uo asuaoll sigj daayi -Mel jo lgleuad aapun 4.jue ao uos.ied /Cue of pau6lsse ao dual aq jouueo pus `a6allnlad e si asuaoll .inok -suopin6a.i pue sMe-1 leaauaE) sjasnLloesselN o} joafgns sl asuaoll. sliU -eouepuodsaaaoo aay10 Aue puL, uol;eallddy leMauaH anoA jo 6ulilew aado,id aqj ainsue o; suol}ona}sul ao} Idp/Ao6•ssew :je ails gash ano :PslA `paioaaaoo aq 01 speou ao `ale,inooeul sl `paAo.gsap ao pa6ewep `Isol sl asueog jnoA 11 INVJLHOdWi Date. 041.`..7 ......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... ..q.........�..! ..W. ................................................. `has permission to perform ...... �.G... plumbing in the buildings of........,/�.......................................... at .................. :9.�.........�.�... .- .........�-............. North Andover, Mass. Fee.�.-P...'....... Lic. No..3-] .................................................................................... 1� PLUMBING INSPECTOR Check # Mlc�— "I h1 vV\%Prl �c- P2-w-tM,a-- No I2411- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY I North Andover MA DATE 09/0812015 PERMIT # JOBSITE ADDRESS 243 Great Pond Road OWNER'S NAME Stephan Boyko P OWNER ADDRESS TEL 978 886-4863 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION: ® REPLACEMENT: Q PLANS SUBMITTED: YES ❑ NO❑ FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM��a_�� DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM'S DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 'L3 p E1 �,rAL DRINKING FOUNTAIN -[j FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY _ ROOF DRAINSHOWER STALL L= jl�o� SERVICE/MOP SINK === TOILET tRINAL WASHING MACHINE CONNECTION ATERHEATERALLTYPES�-_j WATER PIPING - OTHERiQ� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ❑ NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my kno e and that all plumbing work and installations performed under the permit issued for this application will be in com I' i a ertinent pr vision e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. O er" PLUMBER'S NAME I Thomas Weeks LICENSE # 8437 SIGNATURE MP F1 JP'71 CORPORATION ❑# 3083C PARTNERSHIP❑#LLC E]# COMPANY NAME DiPietro Heating and Cooling ADDRESS � 5 South Summer Street CITY' Bradford ISTATE MA ZIP 101835 TEL 978-372-4111 FAX 978-241-7325 CELL IEMAIL j deanna@calldipietro.com AMA V "I h1 vV\%Prl �c- P2-w-tM,a-- No I2411- Date ....°�.....,f.1 ................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Thlis certifies that ...... ................................................................................................ hat permission for gas in allation ....... .................................................... ...................... in the buildings C�o I- 11Lo .......................................................................... ) North Andover, Mass. at ... ............................ ...... �A ............ . Fee. ... Lic. Nol?�.��j ....... .................................................................... ....... ... ... .. GASINSPECTOR Check# I� 101 86 r—� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK z CITY North Andover MA DATE 09/08/2015 PERMIT # t JOBSITE ADDRESS 243 Great Pond Road _ 1 OWNER'S NAME Stephan Boy_ko GOWNER ADDRESS _ TEL 978 886 4863 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL -±j- CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - COOK STOVE f _� I r DIRECT VENT HEATER DRYER FIREPLACE < _ FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN _ POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST _ UNIT HEATER UNVENTED ROOM HEATER �i WATER HEATER 1 _� OTHER " INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ! NO _ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY % OTHER TYPE INDEMNITY -- BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER —' AGENT y SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit y�toctipent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASF ITTER NAME Thomas Weeks LICENSE # 8437 SIGNATURE MP MGF . __, JP __ JGF ._, LPGI _ CORPORATION , # 3083C PARTNERSHIP # LLC —�# COMPANY NAME: DiPietro Heating and Cooling_ ADDRESS 5 South Summer Street CITY Bradfrod STATE MA ZIP 01835 TEL 978-372-4111 _ FAX 978-241-7325 CELL EMAIL dean na@c alldipietro.com e '� xl:� o.-..�..... The Commonwealth ofMassachusetts Department ofIndustrial Accidents Office of Investigations ! _ ? 500 Washington Street Boston, MA 02111 X www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Letlibly NaMe viii[Emelt' WMMME •r�T�/Ih1lr1'�Address: &A=cr City/State/Zip: ITOvIV LOA MH U16,--)-) Phone #: 16 ' I Are you an employer? Cite the appropriate box:type of project (required): 1. a I am a employer with 4. ❑ I am a general contractor and I b. Q New construction employees (full and/or part-time)-* have hired the sub -contractors 2- Q I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g. Q Demolition working for me in any capacity. employees and have workers' 9. Q Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.4 Electrical repairs or additions 3. ❑ f am a homeowner doing all work officers have exercised their l 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13-0 Other vAa"Mzl� coma. insurance recuired.l *Any applicant that checks box #1 :oust also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such- tContractors 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 CompanyName: ,1 _ Ai -j Policy # or Self ins. Lic. #: G��J �� 1S Expiration Date: LQ Job Site Address: J ®J6f(at &G( gid City/State/Zip: N . we l Mfi 6 1 D q! 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 here"rtrim r the pains and per r{lties 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 offrcial. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Towa Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone CONTROL# J225693 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and,any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL# J225694 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL# J225692 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lerit or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. I +� Date.....:....�...........:.............: . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that -!w Oe, C-� ................................................................................................ has permission to perform ! e-...... �.3...... .. Lowiring in the building of........''�.... `' at ..................... P.......................................'...... , N Andover, Mass. Fee... 12.5.......... Lic. No. ZG�DI !� ... f. ................................................. ELECTRICAL INSPECTOR Check #2- 2-q a Commonwealth of Massachusetts w Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use JUse Only ► Permit Number I -' ) 5 —' Occupancy and Fee Checked 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: 6/30/2015 City or Town of: North Andover To the inspector of Wires By this application the undersigned gives notice of their intention to perform the electrical work described below. Location (Street & number) 243 Great Pond Rd Owner or Tenant Steve Boyko Telephone No. 978 8864863 Owners Address Is this permit in conjunction with a building permit? YES X NO LJ (Check appropriate box) Purpose of building Utility Authorization No. Existing service Amps Volts Overhead ❑ Underground ❑ No. of meters New service Amps Volts Overhead ❑ Underground ❑ No. of meters Number of Feeders and Ampacity e1y/ Location and nature of Proposed Electrical Work Installation of 43 solar panels — Roof mount. System size of 11.18kW Completion of the following table may be waived by the Inspector of Wires No. of Recessed Luminaires No. of Ceil. -susp. (paddle) fans No of Total Transformers KVA No. of Luminaires Outlets No of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ Below ElNo. of Emergency Lighting Battery units No. of Receptacle Outlets No. of Oil Burners Fire Number of zones Alarms No. of Switches No. of Gas Burners No. of Detection and Initiating devices No. of Ranges No. of Air Total No. of Alerting Devices Cond. tons No. of Waste Disposers Heat pump Number Tons KW No. of Self Contained Detection/Alertin No. of Dishwashers Space / Area heating KW Local Municipal Other ElE:]connection ❑ No. of Dryers Heating Appliances KW Security Systems: * No. of devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters signs Ballasts No. of devices or Equivalent No. Hydro massage Bathtubs No. of Motors Total HP Telecommunications Wiring: Noof devices or E uivalent )ther: Solar Install 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 E Bond ElOther (Specify): 07/23/2015 Estimated Value of Electrical Work $ 35,325 (When required by municipal policy) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC rule 10. And upon completion. I certify, under the pains and penalties of perjury, that the information on this application is tr complete. Firm United Solar Associates, LLC Name: / tc. No.: Licensee: Dan McGrath Signature: C Lic. No.: 20616A (If applicable, enter "exempt" in the license number line) City of Leominster contract.' --'fl u el.. NO.: 855-786-1776 Address: 452 Pleasant Street, Second Floor, Malden, MA 02148 Alt. Tel.. No.: * Security System Contractor License required for this work: If applicable, enter license number here Lic. No.: Owner's Insurance waiver: I am aware that the licensee does not have the liability coverage I am the (check one) Owner El Owner's Agent E]normally required by law. By my signature below I hereby waive this requirement Owner/Agent Telephone '] Signature Number Permit Fee: $e. 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Q0w Z =o UU N J W W N -2 Z Z Q� 88 F5 E N Y L O N N mtn � am N O y m.,OC W UU L 7 s` U LL > Y a 6 w w C) w 0 U H d T- L0U - 0 0 of w D H Z 0 H Q H Z w W' 0 J W Z Q a w N O 2 LL 0 H 2 W 2 M M 0 M M 0 v N 0 M U) M o N 00 N_ I- v co M N 0 N 0 C N rn Cn M N M N £98V-988 (8L6) :8uoyd MW VW `U3AOdNV HIUON dV021 dNOd 1V3U0 £VZ :sseJppV ONAOS 3A31S :eweN jewo;sno LO M NN L.L r i'A Of 0 LL N w- IZ � Z IL M 0 LU LLJ C L,( ~ n W "t 4iQ vi Q W (n CL fa E n c J W Z Q N NMS E caY)cn py c�aa'Qr'C)"W16 Q D 2 o c c Z �1ZI—uomw o 0 i �— U D O 000Z) �� H O w F- H W U) LL w of u011e1jelsul Jejos Weibel(] gull quo 'OUI 6uiAij dgjs IXGN T n M 0) M I adoa allod lv3aD Adnn3niaa v CL N *(s90 ..w.26* suoplos A6aaua awou 1" aIAII dais vau 4i 0 :: next step Living TM home energy solutions Town of North Andover Building Department 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE: Steve Boyko Residence Solar Panel Installation 243 Great Pond Road North Andover, MA 01845 Structural Assessment of Roof Framing NSL Project No: SP206136 Dear Sirs, 21 Drydock Avenue, 2"`1 floor Boston, MA 02210-2384 866-867-8729 NextStepLiving.com June 20, 2015 Next Step Living, Inc. has performed a limited structural evaluation of the roof framing at the above referenced site to determine if the roof has adequate capacity to support proposed solar PV panels. This analysis has been based on field measurements, framing information and configurations observed at the proposed site. The existing residence is located at 243 Great Pond Road, North Andover, MA 01845. Structural Data and Code Information Our analysis has been performed in accordance with the requirements of the MA Residential Building Code 780 CM R — Eighth Edition. Roof 1 of this residence is framed with conventional roof rafters with collar ties in a gable configuration. Roofs 3 and 4 as well as Roofs 2 and 5 of this residence are framed with conventional roof rafters with collar ties in hip roof configurations. The existing roof structure is in good condition and currently has one layer of asphalt shingles as roof covering. The pertinent data is listed below: Roof 1 Rafters: i %" x 9" (#2 Spruce Pine Fir, Hem Fir, D Fir Assumed) Rafter Spacing: 16" on center Roof Slope: 35 Degrees Horizontal Projected Length of Rafter: 9.5 feet Ceiling Joists: Present Collar Ties: Present every rafter Roof Sheathing: Plywood sheathing Roof Covering: Asphalt shingles Condition of Framing: Good Ground Snow Load, Pg.: 50 PSF from Table 8301.2 (5) Importance Factor, I: 1.0 Exposure Factor, Ce: 1.0 (Partially Exposed) Steve Boyko Residence Solar Panel Installation 243 Great Pond Road North Andover, MA 01845 Page 2 Thermal Factor Ct: 1.0 Existing condition (Warm Roof) 1.1 With panels (Cold Roof) Design Snow Loads: 30.63 PSF (Existing — Unobstructed Warm Roof) 22.45 PSF (New Condition — Slippery Surface on Cold Roof) Basic Wind Speed: 100 MPH from Table R301.2 (4) Importance Factor: 1.0 Exposure: B Roofs 3 and 4 Rafters: I %" x 9" (#2 Spruce Pine Fir, Hem Fir, D Fir Assumed) Rafter Spacing: 16" on center Roof Slope: 35 Degrees Horizontal Projected Length of Rafter: 11.33 feet max - varies Ceiling Joists: Present Collar Ties: Present every rafter Roof Sheathing: Plywood sheathing Roof Covering: Asphalt shingles Condition of Framing: Good Ground Snow Load, Pg.: 50 PSF from Table R301.2 (5) Importance Factor, is 1.0 Exposure Factor, Ce: 1.0 (Partially Exposed) Thermal Factor Ct: -1.0 Existing condition (Warm Roof) 1.1 With panels (Cold Roof) Design Snow Loads: 30.63 PSF (Existing— Unobstructed Warm Roof) 22.45 PSF (New Condition — Slippery Surface on Cold Roof) Basic Wind Speed: 100 MPH from Table R301.2 (4) Importance Factor: 1.0 Exposure: B Roofs 2 and 5 Rafters: 134" x 9 %" (#2 Spruce Pine Fir, Hem Fir, D Fir Assumed) Rafter Spacing: 16" on center Roof Slope: 33 Degrees Horizontal Projected Length of Rafter: 11.33 feet max - varies Ceiling Joists: Present Collar Ties: Present every rafter Roof Sheathing: Plywood sheathing Roof Covering: Asphalt shingles Condition of Framing: Good Ground Snow Load, Pg.: 50 PSF from Table R301.2 (5) Steve Boyko Residence Solar Panel Installation 243 Great Pond Road North Andover, MA 01845 Page 3 Importance Factor, I: Exposure Factor, Ce: Thermal Factor Ct: Design Snow Loads: Basic Wind Speed: Importance Factor: Exposure: Analysis Results General 1.0 1.0 (Partially Exposed) 1.0 Existing condition (Warm Roof) 1.1 With panels (Cold Roof) 32.38 PSF (Existing — Unobstructed Warm Roof) 23.76 PSF (New Condition — Slippery Surface on Cold Roof) 100 MPH from Table R301.2 (4) 1.0 B The proposed solar panels impose a total weight of approximately 3 pounds per square foot (PSF) on the roof surface. The international Residential Building Code allows up to two (2) roof coverings on a residential dwelling. Each roofing layer of asphalt shingles imposes a dead load of 2.5 to 3.0 (PSF) on the roof. Because the existing roof has only one layer of shingles, the code allows a second layer to be added without analysis. The weight of the second layer of shingles is approximately the same as the solar panels which will be installed instead of the second layer of shingles. Solar panels are considered a slippery surface and are mounted a small distance above the existing roof. Therefore, one would be cautious in considering a thermal factor, Ct, of 1.1, treating the panel surface as a cold roof, rather than a warm roof. After considering the roof slope factor, Cs, from figure 7-2, ASCE 7-10, the snow load is reduced by 27% for all solar roof planes compared with the snow loading on the existing shingled roof, which is not considered a slippery surface. The reduction in snow load due to this consideration is about 8.18 PSF for Roofs 1, 3 and 4 and around 8.62 PSF for Roofs 2 and 5, which essentially offsets the weight of the solar panels. Gravity Loadine• Given the size, spacing and configuration of the existing roof framing, we have determined that the existing framing for the residence is adequate to support the additional loading from the weight of the solar —electric system, including the panels, racking system, and all connections without any need for additional bracing or framing members. The panels will be installed using Unirac Solar Mount rails with L -brackets in a landscape configuration with a rail toward the top and bottom of each panel edge. The L -brackets will be fastened directly to the roof rafters with 5/16" diameter lag screws. Steve Boyko Residence Solar Panel Installation 243 Great Pond Road North Andover, MA 01845 Page 4 The fastener layout shall start near each corner and for landscape orientation shall have a maximum spacing of 36" on center parallel to the roof slope and 48" on center perpendicular to the slope (e.g., every third rafter), except the maximum spacing shall be 32" on center perpendicular to the slope (e.g., every other rafter) if the rail and roof attachment are within six (6) feet of the edge of the roof. Each 5/16" diameter lag screw shall have a minimum of 2.5" thread penetration into the existing rafter. It is also important that the L -bracket attachment locations be staggered between adjacent rails so that no single rafter supports more load than under the existing conditions. Wind Loadine: Provided that the L -bracket attachments to the roof are made in a typical staggered pattern, the overall wind loading imposed on the structure will not be impacted to any great extent. The net wind loads on the roof framing with attachment spacing as described above will be less than the current loading on the rafters. Conclusions: Our evaluation of the proposed solar- electric installation has established that the roof framing is adequate to support the addition of the solar panels to the existing roof as indicated on the Solar PV plans. We have only reviewed the adequacy of the connection to the existing rafters and the capacity of the existing rafters to support the vertical and lateral loads from the solar electric system. We do not take responsibility for any other portion of the solar panel array support system, the existing roof framing construction, or the integrity of the structure as a whole. Do not hesitate to contact my office at 866-867-8729 should you have any questions or if you require any additional information. Respectfully, Next Step, Living, Inc. MA Prof. Eng. License # 50405 OWNER'S AUTHORIZATION FORM For Permit Application(s) The sole purpose of this form is to provide Next Step Living with the Necessary permission from the Owner to file Permit Application(s) for such Project work as agreed upon between the Owner and the Owner's Authorized Company and its designated subcontractors. Owner's Name: Steve Boyko Solar Project Address: 1 243 Great Pond Road North Andover, Ma. Signature: Owner's Authorized Company: Next Step Living Inc. Company's Address: 21 Dry Dock Avenue South Boston, MA 02210 Affiliation: Contractor Applicable License: HIC #162111 State: MA Next Step Living, Inc. Date of Contract: 4/25/2015 CT HIC.0629266 • MA OCABR #162111 • RI Contractor Reg. #37185 .: next step living,. home energy solutions 21 Drydock Avenue, 2nd Floor. Boston, Massachusetts 02210 Customer(s) Name(s): Steve Boyko Telephone: 866-867.8729 • www.nextsteptiving.com Customer(s) Street Address: 243 Great Pond Rd City: North Andover State: MA ZIP: 01845-3028 Customer(s) Home PhoLhe #: Customer(s) Mobile Pho%e #: J Permit(s) Required: Building & Electrical City/County Issuing Permit(s): North Andover Customer(s) jointly and severally agrees to purchase the products and/or services of Next Step Living, Inc. ("Contractor") in accordance with the terms and conditions described on the front and reverse of this Home Improvement Agreement ("Agreement') and the attached specification sheet(s). Customer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. ESTIMATED STARTING DATE: Friday, July 24, 2015 ESTIMATED COMPLETION DATE: Friday, July 31, 2015 TOTAL SOLAR SYSTEM PRICE: $69,324.97 PAYMENT METHOD: iselect option(s) ESTIMATED STATE REBATES: $0.00 BCash eCredit Card SOLAR PURCHASE PRICE: $69,324.97 Check Financing ROOFING PURCHASE PRICE: $0.00 TOTAL PROJECT PURCHASE PRICE: $69,324.97 See Payment Certificate for payment schedule In certain circumstances, Customer(s) may agree to assign to Contractor the right to receive and retain the rebate(s) associated with ownership and use of the product(s) in consideration of a reduction to the Total Price equal to the amount of the rebate. By signing below, Customer(s) hereby irrevocably assigns to Contractor the right to receive and retain such rebate. Owner agrees to provide all required support to receive the rebate. Amount $0.00 (Customer's Initials) I'm fine receiving autodialed and/or pre-recorded calls or text messages from or on behalf of Next Step Living to tell me about new products, sales or other events I may be interested in, and you can use any of the telephone numbers I have provided above. I understand my approval to receive these calls is not required for me to make a purchase. (Signature) Customer(s) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing any of the terms of this Agreement. Customer(s) acknowledges that Customer(s) (1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two accompanying Notices of Cancellation, on the date first written above and (2) was orally informed of Customer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. NEXT STEP LIVING, INC. By: William Martin 4/25/2015 (Print Name Lic. #onl CT j Signature Date ( Y) CUSTOMER(S)4u� Stephen Boyko 4/25/2015 iPrint Name_ __f Signature 11 _pate [Print Name _J Signature Date YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. © BLLP2013.NSL.CTMARI TSM260-M43-IVD5250-DC3700-IRO-CC29325-RN-TN-Green Sky ADDITIONAL TERMS AND CONDITIONS (Connecticut Customers Only) The owner(s) of the home improvement contractor is or has been a shareholder, member, partner, or owner of the following corporations, limited liability companies, partnerships, sole proprietorships or other legal entities that have been a home improvement contractor during the previous five years: None. (Massachusetts Customers Only) In Massachusetts, all contractors and subcontractors must be registered by the administrator of the Board of Building Regulations and Standards and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, Massachusetts 02116 Telephone: (617) 973-8700. Any deposit required under this Agreement to be paid in advance of the commencement of work shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties. In Massachusetts, the contractor is responsible for applying for and obtaining any and all necessary permitting. Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts law. Delay/Unknown Conditions: Contractor's failure to perform any term of this Agreement due to conditions beyond its control such as, but not limited to acts of God, material shortages, Customer's inability to qualify for or obtain financing, delays by local government authorities in issuing or otherwise approving inspections, permitting, or other required authorizations do not constitute abandonment and are not included in calculating time frames for performance by Contractor. Contractor and Customer(s) have determined that a definite completion date is not of the essence to this Agreement. Late Cancellation/Late Payment/Default: If Customer(s) attempts to cancel this Agreement after midnight of the third business day after the date of this Agreement, and Contractor accepts such cancellation, all work will be stopped as promptly as is reasonably possible and Customer(s) agrees to pay Contractor a cancellation fee equal to 15% of this Agreement's purchase price to offset Contractor's incurred labor, administrative, and material costs. Customer(s) agrees to pay a late fee of 1.5% per month on all amounts due and owing from Customer(s) to Contractor accruing from the date due and running to the date the payment is made. If Customer(s) is in default of this Agreement, Contractor shall be entitled to seek recovery of Contractor's attorney's fees and any other costs or expenses of repossession or collection from a court of law. Contractor's Right to Cancel: In the event that Contractor determines that this Agreement cannot be performed as intended by the parties due, for example, to incorrect pricing, unforeseen structural defects, or pre-existing conditions to Customer's property, Contractor may cancel this Agreement within Forty -Five (45) days of its execution, notify Customer(s) of such cancellation in writing, and return all money paid by Customer(s). No Set -Offs or Retentions: Upon completion of Contractor's work under this Agreement, Customer(s) shall pay all amounts due under this Agreement without any right of set-off or retention. Completion is defined as the job being materially completed, functional as intended, and a final inspection, permit or occupancy certificate, as the case may be, having been obtained. If after paying all amounts due, Customer(s) alleges that Contractor's work is defective, Contractor, without waiving any of its rights, shall inspect the work and perform any remedial work to the extent Customer(s) is entitled to under this Agreement or Contractor's warranty at no cost to Customer(s). Customer's Representations: Customer(s) represents that (a) Customer(s) owns the premises where the work is being performed, (b) the property is free of preexisting hazards, (c) Customer(s) maintains casualty insurance on the property covering the work performed, (d) if the existing electrical service at the property does not meet the standards of the utility company or electrical code, Customer(s) will make the necessary changes at Customer's expense unless Contractor has agreed to make these changes in writing. Contractor's Rights: Contractor accepts no responsibility for any damage resulting from pre-existing structural or other defects in Customer's property and Contractor is not responsible for remedying structural defects in Customer's property. Contractor shall not be responsible for (a) any damages arising in whole or in part from any causes beyond Contractor's control; (b) any incidental or consequential damages, including but without limitation, lost profits or reduction in value of Customer's property arising from Contractor's delay in performing under this Agreement or due to Contractor's breach of this Agreement; and (c) unintentional damage to Customer's personal property, it being understood that Customer(s) is responsible for protection and/or moving of such items prior to commencement of work. Customer(s) agrees to indemnify and hold Contractor and its employees, agents, and subcontractors harmless from any claims as to the identification, detection, abatement, encapsulation, or removal of mold, asbestos, lead-based products, or other hazardous substances inside or outside of the property at which work is performed. Any surplus materials remain the property of Contractor. Any manufacturers' warranties offered by the manufacturer of the products purchased shall be provided to Customer(s). No warranty will be effective while a balance due TSM260-M43-IVD5250-DC3700-IRO-CC29325-RN-TN-Green Sky remains on this Agreement. Rebates: Unless Customer(s) has assigned its rights to Contractor, Customer(s) shall be entitled to receive and to claim any and all rebates and any other benefits associated with ownership and use of the product(s). Customer(s) shall have the sole responsibility of making any application for any such benefits. Contractor shall have no obligation and assumes no responsibility to apply for or collect any benefits on Customer's behalf nor has Contractor made any representation or warranty to Customer(s) with respect to Customer's eligibility to receive, or the value of, any such benefits, including any net metering credits or solar renewable energy certificates. In all cases, Customer(s) agrees to consult with the relevant governmental officials and Customer's professional tax preparer when evaluating Customer's eligibility for and the financial and tax consequences of receiving benefits. The Attachment includes a summary and estimate of the benefits that may be applicable to the product(s), plus the estimated net cost to Customer(s) after application of such financial incentives; contingent in each case upon Customer(s) receiving or being eligible to receive such benefits. Security Interest: Customer(s) agrees and understands that in the event that Customer(s) does not pay Contractor any of the money owed when it is due, Contractor may have a claim against Customer(s) that may be enforced against Customer's property in accordance with the applicable lien laws. Customer(s) also understands that if Customer(s) finances the work with Contractor or a third party, Customer's separately provided financing documents may include a security interest. Customer(s) understands that Customer(s) should read those documents closely. Miscellaneous: No waiver of any breach of this Agreement shall be construed as a waiver of any prior, concurrent, or subsequent breach hereof. The section headings contained in this Agreement are inserted for convenience only and shall not affect in any way the meaning or interpretation of this Agreement. In construing this Agreement, the gender and number of words used may be changed to meet the context. This Agreement shall be governed by and construed in accordance with the laws of the state in which it is performed, except as may be preempted by federal law. If a provision of this Agreement is held to be invalid or unenforceable, this Agreement shall continue in full force and effect and shall be construed as if the invalid or unenforceable provision was omitted. Customer(s) agrees that Contractor can assign any of Contractor's rights under this Agreement without Customer's consent and that the person to whom Contractor assigns this Agreement shall be entitled to all of Contractor's rights under this Agreement. The Purchase Price listed on the front of this Agreement includes all applicable sales tax and all governmental fees required for Contractor to perform this Agreement. To the extent any goods or material are not specifically listed in this Agreement but are necessary to complete the work, Contractor will select goods and materials of commercial grade (i.e., of the grade, type, or condition, ordinarily or customarily used for such work), such selection being at the sole discretion of Contractor. Contractor may engage independent subcontractors to perform work under this Agreement. Five -Year Warranty: Contractor warrants its workmanship under this Agreement for a period of five (5) years. In the event of a valid claim, Contractor will repair or replace, at its option, and at its sole expense and at no cost to Customer(s), any defects in workmanship provided by Contractor or its subcontractors. Effective immediately upon Customer(s) making of the final payment under this Agreement, Contractor assigns to Customer(s), to the extent assignable, any and all manufacturer warranties covering the equipment and shall deliver copies of such warranties after its receipt of such final payment. No warranty will be effective while a balance due remains on this Agreement. Documents Incorporated by Reference: Specification Sheet(s), Notice of Cancellation CLASS ACTION WAIVER: Customer(s) agrees that Customer(s) will assert a dispute, claim, or controversy (hereafter referred to as a "Claim") arising under or relating to this Agreement only on behalf of Customer's own self and that Customer(s) will not assert a Claim on behalf of, or as a member of, a class or group in either an arbitration proceeding, a private attorney general action, or in any other forum or action. If a court determines that this specific paragraph is not fully enforceable, the court's determination shall be subject to appeal. This paragraph does not apply to any lawsuit or administrative proceeding filed against Contractor by a state or federal government agency even when such agency is seeking relief on behalf of a class of Customers. TSM260-M43-IVD5250-DC3700-IRO-CC29325-RN-TN-Green Sky Next Step Living, Inc. Date of contract: 4/25/2015 l JI Customer(s) Name(s): Steve Boyko i CT HIC.0629266 • MA OCABR #162111 • RI Contractor Reg. #37185.y 0 inext step Living,. home energy solutions Drydock Avenue, 2nd floor, Boston, Massachusetts 02210 Telephone: 866-867-8729 • www.nextstepllving.com Customer(s) Street Address: 243 Great Pond Rd City: North Andover State: MA zip: 01845-3028 Customer(s) Home Phon N Customer(s) Mobile Phone #: Permit(s) Required: Building & Electrical City/County Issuing Permit(s): North Andover The Customer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services listed below, in accordance with the prices and terms described on this Specification Sheet and the front and the reverse of the accompanying HOME IMPROVEMENT AGREEMENT, of which this Specification Sheet is a part. Description of the Solar Project and Description of the Significant Materials to Be Used: (1) delivery of solar equipment, (2) complete installation to manufacturers specifications, (3) installation of inverter, conduit runs, and racking system as needed. and (4) cleanup after installation. Panel Brand: Trina Solar Panel type: TSM-260PA05.08 Panel Watts (DC STC) - 260 Monitoring system with 5 year service (owners responsibility after 5 years) The solar array will consist of 43 panels for a total system size of 11180 (DC STC) Description of the Rooting Project and Description of the Significant Materials to Be Used: except for areas highlighted in red, which are excluded, (1) delivery of roofing materials, (2) removal of existing roofing material (up to 2 layers) and inspection of roof deck after existing roofing material is removed, (3) recycling of existing asphalt shingles, (4) cutting in ridge venting as needed, (5) six feet of ice and water shield at the eaves and three feet along the rakes and in the valleys, (6) synthetic underlayment covering all other areas, (7) complete installation to manufacturer's specifications, and (8) cleanup after Scope of Work: No roof work being performed by Next Step Living [Color: j Roofing Brand: Owens Coming Roofing type: 30 year architectural Scope of Work: NSL shall perform all work and provide all materials described on the Work Scope attached to this agreement and will be responsible for any and all materials, and appurtenant items as may be required and necessary to perform all work described on the Work Scope and any performance reasonably inferable from it, including clean-up associated with NSL's work. It is agreed and understood by and between the parties that this Specification Sheet, along with the HOME IMPROVEMENT AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both Customer(s) and Contractor. Customer(s) hereby acknowledges that Customer(s) has read this Specification Sheet. NEXT STEP LIVING, INC. By: William Martin iPrint Name Lic. # (CT ;only) CUSTOMER(S) Stephen Boyko 'Print Name 4/25/2015 Signature_ _Date j 4/25/2015 [Signatur Date Print Name LSlgnature Date j ©BLLP2013.NSL.CTMARI TSM260-M43-IVD5250-DC3700-IRO-CC29325-RN-TN-Green Sky ,N ext Step Living,, Inc. CT HIC.0629266 • MA CCABR #162111 • RI Contractor Reg. #37185 next step living, home energy solutions 21 Drydock Avenue, 2nd Floor, Boston, Massachusetts 02210 Telephone: 866-867-8729 • www.nextstepliving.com The following Notice of Cancellation applies to all states. ------ --r--------------------------------- NOTICE OF CANCELLATION NOTICE OF CANCELLATION 4/25/2015 1 Date of Transaction:' Date o_f T_ransaction:l _ You may CANCEL this transaction, without any Penalty or Obligation, within !You may CANCEL this transaction, without any Penalty or Obligation, within THREE BUSINESS DAYS from the above date. If you cancel, any property THREE BUSINESS DAYS from the above date. If you cancel, any property traded in, any payments made by you under the Contract or Sale, and any itraded in, any payments made by you under the Contract or Sale, and any negotiable instrument executed by you will be returned within TEN ,negotiable instrument executed by you will be returned within TEN BUSINESS DAYS following receipt by the Seller of your cancellation notice, IBUSINESS DAYS following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be canceled. If 'and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in ,you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to Isubstantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the 'you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the iinstructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Viand the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you 1you agree to return the goods to the Seller and fail to do so, then your remain liable for performance of all obligations under the Contract. To 'remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram, to Next cancellation notice or any other written notice, or send a telegram, to Next Step Living, Inc., at 21 Drydock Avenue, 2nd Floor, Boston, Massachusetts 'Step Living, Inc., at 21 Drydock Avenue, 2nd Floor, Boston, Massachusetts 02210, 102210, NOT LATER THAN MIDNIGHT OF 4/29/2015 --(pa e) NOT LATER THAN MIDNIGHT OF (Date) —-- -- I HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date !Consumer's Signature Date ------------------------------------------------------------------- In addition to the above notice, the following Notice of Cancellation ___________ _ _ _ _��lies to Rhode Island customers. _ _ FL _ ___________ NOTICE OF CANCELLATION r NOTICE OF CANCELLATION Date of Transaction: Date of Transaction: You may cancel this transaction, without any penalty or obligation, within IYou may cancel this transaction, without any penalty or obligation, within three (3) business days from the above date. If you cancel, your cancellation ithree (3) business days from the above date. If you cancel, your cancellation notice must state that you do not wish to be bound by the agreement and [notice must state that you do not wish to be bound by the agreement and mailed by registered or certified mail not later than midnight three (3) days Imailed by registered or certified mail not later than midnight three (3) days following the buyer's signing the agreement, excluding Sunday and any'following the buyer's signing the agreement, excluding Sunday and any holiday on which regular mail deliveries are not made. All cancellations !holiday on which regular mail deliveries are not made. All cancellations must be mailed to: Next Step Living, Inc., at 21 Drydock Avenue, 2nd Floor, must be mailed to: Next Step Living, Inc., at 21 Drydock Avenue, 2nd Floor, Boston, Massachusetts 02210. ' Boston, Massachusetts 02210. 1 HEREBY CANCEL THIS TRANSACTION. I I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date 'Consumer's Signature Date ---------------------------------L--------------------------------- The above -signed individuals acknowledge receipt of the above Notices of Cancellation, with all blank lines filled in, and further acknowledge that they were orally informed of their right to cancel this transaction. Stephen Boyko [Print Name _ Print Name 4/25/2015 -- — — - — [Signature _ Date J 'Signature _ _ _ _ _ Date _ TSM260-M43-IVD5250-DC3700-IRO-CC29325-RN-TN-Green Sky TSM-DC05A.05 HoneyM IN BLACK DIMENSIONS OF PV MODULE TSM-DC05A.05 E E 0 941 mm Back View I-V CURVES OF PV MODULE TSM -255 DCOSA.05 9.00 -1000 1000W/af ... _`� 8.00--BMWIMr 7.- I 6.- 600w/mr, s.°° - - - N 4,0 A00W/m0 I 2,00 Iro , 0.00 10.00 20.- 3010 40.m Vdtoge(V) ELECTRICAL DATA @ STC TSM -250 TSM -255 TSM -260 TSM -265 DCOSA.05 DC05A.05 DC05A.05 DC05A.05 DC05A.05 Peak Power Watts -PMA■ (Wp) 250 255 260 265 Power Output Tolerance -PMA% (%) ao 0/+3 0/+3 0/+3 0/+3 o Maximum Power Voltage-VMPP (V) 29.8 30.1 30.2 30.6 o Maximum Power Current-IMPP (A) 8.38 8.48 8.61 8.66 Open Circuit Voltage-Voc (V) 38.1 38.2 38.4 38.5 Short Circuit Current-Isc (A) 8.91 8.98 9.15 9.20 Module Efficiency nm (%) 15.3 15.6 15.9 16.2 STC: Irradiance 1000 W/m', Cell Temperature 25"C. Air Mass AM1.5 according to EN 60904-3. oAverage efficiency reduction of 4.5% at 200 w/m' according to EN 60904-1. Cables Photovoltaic Technology Cable 4.0 mm', 1000 mm 3 Connector Original MC4 3 ELECTRICAL DATA @ NOCT TSM -250 TSM -255 TSM -260 TSM -265 DC05A.05 DCOSA.05 DC05A.05 DCOSA.05 Maximum Power -PMA% (Wp) 183 186 190 194 Maximum Power Voltage-UMPP (V) 26.9 26.9 27.0 27.2 Maximum Power Current-IMPP (A) 6.89 6.93 7.04 7.13 Open Circuit Voltage-Uoc (V) 33.8 34.6 34.8 35.0 Short Circuit Current-Isc (A) 7.14 7.20 7.34 7.40 NOCT: Irradiance at 800 W/m', Ambient Temperature 200C. Wind Speed 1 m/s. MECHANICAL DATA Solar Cells Monocrystalline 156 x 156 mm DIN EN 60068-2-68 LC2 Cell Orientation 60 cells (6 x 10) MCS BBA 0016 Module Dimensions 1650 x 992 x 35 mm 0 Weight 18.6 kg R Glass High Transparency Solar Glass 3.2 mm Backsheet Black Modules per box: 29 pieces z Cc CYC G PV CYCLEIQ Frame Black Anodized Aluminium Alloy [� Iwr/I Modules per 40' container. 812 pieces N J -Box IP 65 rated Cables Photovoltaic Technology Cable 4.0 mm', 1000 mm Connector Original MC4 TEMPERATURE RATINGS MAXIMUM RATINGS Nominal Operating Cell 44°C (t2°K) Operational Temperature -40 to +85°C Temperature (NOCT) 10 year Product Workmanship Warranty CERTIFICATION Maximum System IOOOV DC (IEC) Temperature Coefficient of PMA■ -0.41%/OK Voltage Temperature Coefficient of Voc - 0.32%/°K Max Series Fuse Rating 15A Temperature Coefficient of Isc 0.053%/OK IEC 627162 PIG 1917/05.11 Trinasolar Smart Energy Together CAUTION: READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. ® 2013 Trina Solar Limited. All rights reserved. Specifications included in this datasheet are subject to change without notice. WARRANTY 10 year Product Workmanship Warranty CERTIFICATION 25 year Linear Power Warranty IEC61215/EN61215 IEC61730/EN61730 (Please refer to product warranty for details) IEC 627162 PIG 1917/05.11 IEC 61701 DIN EN 60068-2-68 LC2 MCS BBA 0016 0 M R PACKAGING CONFIGURATION Modules per box: 29 pieces z Cc CYC G PV CYCLEIQ [� Iwr/I Modules per 40' container. 812 pieces N V Trinasolar Smart Energy Together CAUTION: READ SAFETY AND INSTALLATION INSTRUCTIONS BEFORE USING THE PRODUCT. ® 2013 Trina Solar Limited. All rights reserved. Specifications included in this datasheet are subject to change without notice. Enphase® M215 Microinverter // DATA INPUT DATA (DC) M215-60-2LL-S22-IG, M215-60-2LL-S25-IG Recommended input power (STC) 190 - 270 W Peak inverter efficiency Maximum input DC voltage 48V 99.4% Peak power tracking voltage 27 V - 39 V MECHANICAL DATA Operating range 16 V - 48 V Enlighten Manager and MyEnlighten monitoring options Min/Max start voltage 22 V / 48 V Max DC short circuit current 15 A OUTPUT DATA (AC) @208 VAC 0240 VAC Peak output power 225 W 225 W Rated (continuous) output power 215 W 215 W Nominal output current 1.03 A (A rms at nominal duration) 0.9 A (A rms at nominal duration) Nominal voltage/range 208 V / 183-229 V 240 V / 211-264 V Nominal frequency/range 60.0 / 57-61 Hz 60.0 / 57-61 Hz Extended frequency range 57-62.5 Hz 57-62.5 Hz Power factor >0.95 >0.95 Maximum units per 20 A branch circuit 25 (three phase) 17 (single phase) Maximum output fault current 850 mA rms for 6 cycles 850 mA rms for 6 cycles EFFICIENCY CEC weighted efficiency, 240 VAC 96.5% CEC weighted efficiency, 208 VAC 96.5% Peak inverter efficiency 96.5% Static MPPT efficiency (weighted, reference EN50530) 99.4% Night time power consumption 65 mW max MECHANICAL DATA integrated into the microinverter. Ambient temperature range -40°C to +65°C Dimensions (WxHxD) 171 mm x 173 mm x 30 mm (without mounting bracket) Weight 1.6 kg (3.4 lbs) Cooling Natural convection - No fans Enclosure environmental rating Outdoor - NEMA 6 Connector type M215-60-2LL-S22-IG: MC4 M215-60-2LL-S25-IG: Amphenol H4 FEATURES Compatibility Compatible with 60 -cell PV modules. Communication Power line Integrated ground The DC circuit meets the requirements for ungrounded PV arrays in NEC 690.35. Equipment ground is provided in the Engage Cable. No additional GEC or ground is required. Ground fault protection (GFP) is integrated into the microinverter. Monitoring Enlighten Manager and MyEnlighten monitoring options Compliance UL1741/IEEE1547, FCC Part 15 Class B, CAN/CSA-C22.2 NO. 0-M91, 0.4-04, and 107.1-01 Frequency ranges can be extended beyond nominal if required by the utility To learn more about Enphase Microinverter technology, [e] enphase® visit enphase.com E N E R G Y 0 2015 Enphase Energy. All rights reserved. All trademarks or brands in this document are registered by their respective owner. MKT -00069 Rev 1.0 1 am UNI RAC• A MTI GROUP MCPAW SolarMount-1 TM Roof Mount Technical ®atasheet Pub 100701 -ltd V1.0 July 2010 SolarMount-I Module Connection Hardware Sliderand Mid Clamp..........................................................................................................1 Sliderand End Clamp......................................................................................................... 2 SolarMount-I Series Accessory Mount................................................................................ 2 SolarMount-I Beam Connection Hardware 1- Flange Foot..................................................................................................................... 3 2- Flange Foot..................................................................................................................... 3 BeamSplice..................................................................................................................... 4 SolarMount-I Beam SolarMount-I Beams................................................................................................ 5 SolarMount-i Module Connection Hardware SolarMount-1 Series Slider with Mid Clamp Part No. 02027C, 02028C, 02029C, 02030C f a.a1s —•{ Y L WX Dimensions specked in inches unless noted • Slider and Mid Clamp Material: One of the following mill finished extruded aluminum alloys: 6005-T5, 6105-T5, 6061-T6 Ultimate tensile: 38ksi, Yield: 35 ksi • Slider weight: 0.026 lbs (12g), Mid Clamp Weight: 0.050 lbs (23g) • Allowable and design loads are valid when components are assembled with SolarMount-I Beams according to authorized UNIRAC documents • Sliders are compatible with SolarMount-I Beams • Assemble with one'/< -20 ASTM F593 bolt and one'/a-20 ASTM F594 serrated flange nut • Use anti -seize and tighten to 10 ft -lbs of torque • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual Applied Load Direction Average Ultimate lbs (N) Allowable Load lbs (N) Safety Factor, FS Design Load lbs (N) Resistance Factor, 4) Sliding, X+ 1194 (5311) 490 (2180) 2.44 741 (3296) 0.620 Tension, Y+ 1503 (6686) 677 (3011) 2.22 1024 (4555) 0.682 Transverse, Zt 1 2080 (9252) 1915 (40 0) 2.27 1383 (6152) 0.665 SolarMount-I module Connection Hardware SolarMount-I Slider with End Clamp Part No. 02001C through 02006C, 02009C, 02010C Y A rX r r OO 0' . •® U N I RAC.- A MITI GRCW CQY. W • Slider and End Clamp Material: One of the following mill finished extruded aluminum alloys: 6005-T5, 6105-T5, 6061-T6 Ultimate tensile: 38 ksi, Yield: 35 ksi • Slider weight: 0.026 lbs (12g), end clamp weight varies based on height: -0.058 lbs (26g) • Allowable and design loads are valid when components are assembled with SolarMount-I 1.0 or 2.5 Beams according to authorized UNIRAC documents • Sliders are compatible with SolarMount-I Beams • Assemble with one'/4-20 ASTM F593 bolt and one'/< -20 ASTM F594 serrated flange nut • Use anti -seize and tighten to 10 ft -lbs of torque • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual • Modules must be installed at least 1.5" from either end of a beam Applied Load Direction Average Ultimate lbs (N) Allowable Load lbs (N) Safety Factor, FS Design Loads lbs (N) Resistance Factor, 0 Sliding. Xt 283 (1259) 104 (463) 2.72 157 (698) 0.555 Tension, Y+ 332 (1477) 1 88 (391) 3.77 133 (592) 0.401 Transverse, Zt 1 1367(6 81) 1 533 (2371) 2.56 1 806 (3585)l 0.590 Dimensions specified in inches unless noted SolarMount-1 Accessory Mount Part No. 08010M Y �X Dimensions specified in inches unless noted Slider Material: One of the following mill finished extruded aluminum alloys: 6005-T5, 6105-T5, 6061-T6 Ultimate tensile: 38 ksi, Yield: 35 ksi Slider weight: 0.026 lbs (12g) Allowable and design loads are valid when components are assembled with SolarMount-I 1.0 or 2.5 Beams according to authorized UNIRAC documents SolarMount-I Series Accessory Mounts are compatible with SolarMount-I Beams Use two Accessory Mounts per accessory Assemble each pair of clamps with the following stainless steel hardware: two Y-20 set screws, two Y-20 heavy hex jam nuts, and two %-20 F594 serrated flange nuts Use anti -seize and tighten to 5-10 ft-Ibs of torque Resistance factors and safety factors are determined according calculations and UNIRAC testing Maximum distance of Maximum weight of accessory center of gravity accessory from beam center lbs (kg) in (mm) 7 (178) 32 (14.5) 2 Delivering Value through Innovation SolarMount-I Beam Connection Hardware SolarMount-I 1- Flange Foot Part No. 04044RA �' Beam Y f -Flange Foot A- :"UNIRAC A M11 GROUP COMPAW I -Flange Foot Material: One of the following mill finished extruded -- aluminum alloys: 6005-T5, 6105-T5, 6061-T6 Ultimate tensile: 38 ksi, Yield: 35 ksi • section 9 of the 2005 Aluminum Design Manual Design and allowable loads are for the beam to foot connection 1 -Flange Foot weight: 0.101 lbs (46 g) Allowable and design loads are valid when components are assembled with SolarMount-1 1.0 or 2.5 Beams according to authorized UNIRAC documents • 1 -Flange feet are compatible with SolarMount-1 Beams • Resistance factors and safety tactors are determined according to part 1 \ ' • Be sure to check load limits for roof attachments and standoffs W . axsa*•..s�sm s_.Se Dimensions specified in inches unless noted Applied Load Direction Average Ultimate lbs (N) Allowable Load lbs (N) Safety Factor, FS Design Load lbs (N) Resistance Factor, m Tension, Y+ SolarMount-1 1.0 Beam 1388 (5952) 591(2629)1 2.26 894 (3977) 0.668 SolarMount-I 2.5 Beam 1514 (6735) 648(2882)1 2.34 1 980 (4359) 0.647 Compression, Y- SolarMount-I 1.0 Beam 2931 (13038) 1288 (5729) 2.28 1948 (8665) 0.664 SolarMount-I 2.5 Beam 2750 (12233) 1223 (5440) 2.25 1&49(8225) 0.672 Transverse, X-, downhill 635 (2825) 313 (1392) 2.03 473 (2104) 0.745 Transverse, X+, uphill 42 (187) 20 (89) 2.15 30 (133) 0.705 Sliding, Zt I (see Beam Splice) SolarMount-I 2 - Flange Foot Part No. 04002M, 04003M Y '1- W X. aaa)wso.fxa4r D L} )XI Dimensions specified in inches unless noted 2 -Flange / Foot • 2 -Flange Foot Material: One of the following mill finished extruded aluminum alloys: 6005-T5, 6105-T5, 6061-T6 Ultimate tensile: 38 ksi. Yield: 35 ksi • 2 -Flange Foot weight: 0.103 lbs (47 g) • Allowable and design loads are valid when components are assembled with SolarMount-I 1.0 or 2.5 Beams according to authorized UNIRAC documents • 2 -Flange Feet are compatible with SolarMount-I Beams • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual • Design and allowable loads are for the beam to foot connection • Be sure to check load limits for roof attachments and standoffs Applied Load Direction Average Ultimate lbs (N) Allowable Load lbs (N) Safety Factor, FS Design Load lbs (N) Resistance Factor, m Tension, Y+ SolarMount-I 1.0 Beam 1931 (8950) 864 (3843) 2.23 1307(5814)1 0.667 SolarMount-I 2.5 Beam 2478 (11023) 1111 (4942) 2.23 1 1681 (7477) 1 0.678 Compression, Y- SolarMount-I 1.0 Beam 3788 (16850) 1706 (7589) 2.22 2581 (11481) 0.681 SolarMount-12.5 Beam 3694 (16432) 1562 (6948) 2.36 2363 (10511) 0.640 Transverse, X-, downhill 635 (2825) 313 (1392) 2.03 473 (2104) 0.745 Transverse, X+, uphill 42 (187) 20 (89) 2.15 30 (133) 0.705 Sliding, Zt I (see Beam Splice) SolarMount-I Beam Connection Hardware SolarMount-I Beam Splice Part No. 03020M, 03021M 1 -Flange or 2 -Flange Foot P"r =1F • • E X Dimensions specified in inches unless noted ::OUNIRAC•, • Beam Splice Material: Aluminum 5052-1-132 Ultimate tensile: 31 ksi, Yield: 23 ksi • Beam Splice weight: 0.053 lbs (24 g) • Allowable and design loads are valid when components are assembled according to authorized UNIRAC documents • Beam Splices are compatible with SolarMount-i Beams when used with 1 -Flange or 2 -Flange feet • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual Applied Load Average Allowable Safety Design Resistance Direction Ultimate Load ' Factor, Load Factor, lbs (N) lbs (N) FS lbs (N) 00 Sliding, # 1428 (6352) 620 (2758) 2.30 938 (4172) 0.657 F4 ■ ::�UI�IRAC A WTI (fit" CO~ SolarMount-I Beam MATERIAL: One of the following extruded aluminum alloys: 6005-T5, 6105-T5, or 6061-T6, Mill Finish Properties Approximate Weight (per linear ft) Units plf Beam Height (in) 1.094 0.356 2.500 0.548 Total Cross Sectional Area int 0.3037 0.4665 Section Modulus (X -Axis) in -3 0.1101 0.3687 Section Modulus (Y -Axis) in 0.0390 0.0422 Moment of Inertia (X -Axis) in 0.0602 0.4609 Moment of Inertia (Y -Axis) in 0.0195 0.0211 Radius of Gyration (X -Axis) in 0.4453 0.9940 Radius of Gyration (Y -Axis) in 0.2536 0.2127 �. 1.094 0.347 SolarMount 1.0 Beam Height = 1.094" Part No. 10144M Y One 00.281 hole is 1.188" i from each end of the beam DC Power Systems (800) 967-6917 www4cpower-systerns,c4m l 1.406 zsrw 0.547 SolarMount 2.5 Beam Height = 2.500° Part No. 11192M Y Two 00.281 holes are 1.188" A -ie X from each end of the beam -- ► X Dimensions specified in inches unless noted � C'HUSrrr - - _ _ Y COMM W TH MASU ELECTRICIANS Ir "m 510332806 ISSUES THE FOLLOWING LICENSE AS A- REG JOURNEYMAN ELECTRI Ci AN DANIEL J MCGRATH O.'WLIM., TH kay r` 114 BOYLSTON ST Q,�,�`'-�1n�- :oo,raaa+�r.r,•wsw MALDEN MA 0214$-7931�� 11467 B 07/31/1b -fr,/rlt MnSaehuSMS - DQPSrtmcnt of Pubic S&'Cty - F Board of Builbng Rcgu:Z A::s and S:nnda"ds LCOM: CSFA-10476 DANIEL J MCGRATH – — 114 BOYIMON ST _ IVFALDEN MA 02149 ` Exp.r=cn Coins, i loner 09/15/2016 ELECTRICAL UNLIMITED JOURIAEYPERSON DANIEL] MCGRATH 114 BOYLSTON ST MAL.DEN, MA 02148-7931 JC. REG NO iY i+fgP§_- LC.01992i3-E2 10/01/2014 09/30/2015 GNED � t 09MM—E rnams+d.e oMlrw+�MfsiMlw�l M • 10+4v OR.p+farFAA�' C.•w.�wi�'_ L DaMe> I M aGVeth Keith JE prenddrVIIIIet SAW"" (n•rwr+rtir–r�orwq---------- tCyu••i/rw! PRoffice of Consumer Attsirs &Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 168524 Type: piration: 3/7/2017 Individual DANIEL MCGRATH DANIEL MCGRATH 114 BOYLSTON ST MALOEN, MA 02148 — � `� ;: ��-� •_� Undersecretary ISSUED Aug 26, 2013 EXPIRES Aug 31, 2015 STATE OF MAINE r• i `: „� bEPTELE� 4 _ � OF N BOARD LICENSE 111 MSM20703 DANIEL MCGRATH MASTER ELECTRICIAN ISSUED Aug 26, 2013 EXPIRES Aug 31, 2015 The Commonwealth of Massachusetts Department of Industrial Accidents r a d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Il'orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaulicant Information Please Print Leeibly Name (Business/Organization/Individual): United Solar Associates, LLC Address: 452 Pleasant Street, Second Floor City/State/Zip: Malden, MA 02148 Are you an employer? Check the appropriate box: Phone #: 855-786-1776 1.M I am a employer with 5 employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13.E:] Roof repairs 14. ❑✓ Other Solar Install *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. tContractors 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: TRAVELERS Policy # or Self -ins. Lic. #: 7PJUB-5B50763-8-14 Expiration Date: 7/23/2015 Job Site Address: 234 Great Pond Rd City/State/Zip: N.Andover, MA 01845 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveral;e verification. �--� I do hereby certify under th4paiip and 855-786-1776 information providedaboveis true and correct. Date: kn /� -0 l ,QC) f'T Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone €` CERTIFICATE OF LIABILITY INSURANCE DATE M/DD YYYY) 5/20/20 20/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR 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. POLICY NUMBER 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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). GENERAL LIABILITY PRODUCER NAME: ASSET ONE INSURANCE SERVICES 575 Anton Blvd 3rd Fl AHO No Ext: 714 625-8204 (,CC, No): (714) 625-8290 AODREss: aagopian@gmail . com Costa Mesa, CA 92626 OE66207 X COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Westchester Surplus Linea Insurance Company INSURED United Solar Associates, LLC INSURER B: INSURER C: CLAIMS -MADE _I OCCUR INSURER D: 300 Brickstone Square., Suite 201 INSURER E: Andover, MA 01810 A INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADDL g SUBR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS P: 978-688-9545 F: 978-688-9542 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 50,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE _I OCCUR MED EXP (Any oneperson) $ 10,000 A G27527966 001 11/10/14 11/10/15 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 11000,000 POLICY W PEa LOC $ AUTOMOBILE LIABILITY Ea accident $ BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS t BODILY INJURY Per accident) $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE G27527966 001 11/10/14 11/10/15 EACH OCCURRENCE $ 5,000,000 AGGREGATE s 5,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N X VJC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? N / A E.L. DISEASE- EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE- POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule, if morespace is required) Certificate Holder is named Additional Insured. CERTIFICATE HOLDER CANCELLATION Town of North Andover Attn: Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 P: 978-688-9545 F: 978-688-9542 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD From: 6513107911 Page: 2/2 Date. 7/23/2014 7:14:02 AM :X. ICFRTIFICATF OF 11AR11 ITV INSIIRON('_F DATE(MMIDDYYY) TWS4ERMFICATE 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 polioy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX LOPRIORE INS AGENCY INC 426 MAIN STREET SUITE 2 (A1C, No, Ext): (A/C, No): E-MAIL STONEHAM, MA 02180 ADDRESS: 15MTK INSURER(S) AFFORDING COVERAGE NAIC of INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA UNITED SOLAR ASSOCIATES LLC INSURER B: INSURER C: INSURER D: 114 BOYLSTON STREET INSURER E: MALDEN, MA 02148 INSURER F: F-. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH19IS70CFRIFVT14ATTHF POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANONG ANY REOUIRFMENT, 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIMMYYYY) )MMKDD`,YYYY) LIMITS GENERAL LIABILITY AC-,IOCCURRENCE $ COMMERCIAL GENERA_ LIASI-ITY AMAGETO RENTED $ IREMIPEP, (Es nrri.rrenre) CLAIMS MADE F-1 OCCUR. ED EXP (Any one person) $ ERSONAL R ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY O PROJECT O LOC ENEP.AL AGGREGATE RCDUCTS - COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION ANDIW EMPLOYER'S LIABILITY Y,N UB -5B507638-14 07/23/2014 07/2312015 C STATUTORY X X I LMITS OTHER ANY PROPERITOR/PARTNER/EXECUT VE OFFICER/M=MBER EXCLUDEC? WA E. L EACH ACCIDENT $ 1,000,000 =EASE- - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, cescribe uncer nFSCRIPTION OF OFFRATCN.R hNow E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCA710NS/VEHICLESfRESTRIC1IONSlSPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CBRTIRCATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER- BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENV\ a�. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1968-2010 ACORD CORPORATION. All rig his reserved. This fax was received by GFI FAXmaker fax server. For more information, visit: http://www.gfi.com Date ..... 3.--.3z Z�..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................D.1.....` <.5 ....... ................... has permission to perform ......!F :T... ll 'As' wiring in the building of .......... P-')zq.y/—i... f.)..................................................................... �t ....7—q.?........................................... . North Andover, Mass. #ee ... tea ... Lic. No. ..1. -�f.. C7 ....&LE � ...........�� ............. RICAL IN0 C 09 Check # V 13107 C'ommonweaAk o/cc7laMachuself Official Use Only 2efrart`=d 115h -e Svvice4 Permit No. 13193 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (teaveblank)' 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) C- trtr Town of: By this application the undersigned gives is or her intention to Location (Street &Number) Date: To the Inspector of Wires: srform theelectrical work described below. Owner or Tenantd j� / IX ,/, p Telephone No. Owner's Address _6! ^-7� Is this permit in conjunction with a b ilding permit? Yes LP Purpose of Building - O e, L Jr No ❑ (Check Appropriate Box) Utility Authorization No.' Existing Service Amps / olts Overhead ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of ProposedElectricalEllectrical Work: Completion o the oflowing table m be waived b the In ector of Wires. No. of Recessed Luminaires 1..2 No. of CeU. Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets 2 No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above ❑ In- ❑ g rnd, rnd. o. o mergency Lighting . Batte Units No. of Receptacle Outlets 27 No. of Oil Burners FIRE ALARMS No. of Zones No, of'Switches No. of Gas Burners No. of Detection andInitiating Deices No. of Ran es g Na of Air Cond. Total Tons . No. of Alerting Devices No. of Waste Disposers P Heat Pump Totals: Number Tons ~-- No, of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑Municipal ❑ Other . Cyyonnection No. of Dryers Heating Appliances KW Securi No of Deice s or Equivalent No. of Watero. Heaters KW of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: '3 - 3/ 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 covera a is in force, and has exhibited proof of same to the permit issuing office. ONE: NE: 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: 2, �B�SJ LGG / LIC. NO.: Licensee: �,' ��yQ Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: _//T i 7Y� 47.24 _,�"6ZZ /Irt1f7 ®.f �f Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Departmenflof Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent, Owner/Agent Signature • Telephone No. PERMIT FEE: $ The Cornnionlvealth of Massachusetts Department of Industrial Accidentts Office oflnvestigations 600 bMashinngtonn Street Boston, MA 02111 ivivl•umass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information % Please Print Legibly Name(Business/Organization/Individual): 1 �/�r,�ip �`�G /G .�`�G�j'6�'s12 Address: `/ )44!2s���_'� —/Dog Cit /State/Zi /y1%�l��dJt°/N� Phone #: R /RK -31 9,5 Y P:d�. Are you an employer? Check the appropriate box: 1. ❑ I am a'employer with �— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ElI am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL i myself. [No workers' comp. c. 152, § 1(4), .and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. p Remodeling 8. ❑ Demolition 9. ❑ Building addition I O.MlElectrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box ft must also fill out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such (Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy inforrnation. I am art employer that is providing workerscompensation insurance for my employees. Below is the policy and job site fnforntatiort. Insurance Company Name:.X441e4- Policy # or Self -ins. Lic. M %D D0 1,7,3 7. Expiration Date: Job Site Address: 2�� �G��%��t7/ %� City/Stale/Zip:&jyLi�cyG�/Ji'!i},t�f,7 Atl ch a copy of the workers' compensation policy declaration page (showing the policy number and expiriation date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Cine 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 terrify under the pains ar�ialties perjury that the information provided above is true and correct Signature: Date. Phone #: 0, 1!!,P0S Oficial use only. Do not write in this area, to be completed by city or towit official. City or Town: Perntit/License # Issuing Authority (circle one): LL.IBoard of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5..Pluttibing Inspector ther tact Person: Phone #: BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O. BOX 8294 SALEM, MA 01971-8294 TEL. (978) 741-5731 FAX (978) 740-9109 claimsp_butterworthotoole. com 01/16/2013 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall ADDRESSES North Andover, MA 01845 RE: Insured: Stephen Boyko Address: 243 Great Pond Road City/Town Hall North Andover, MA 01845 North Andover, MA 01845 Policy No.: 2419456 Loss of: 01/12/2013 Wind File or Claim No.: 031-0056 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Brad Doherty Adjuster Member of National Association of Independent Insurance Adjusters / Date. �0 //.?- ........ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION � Mu , This certifies that .. 4r?. 1-11,1qn .......... ...... . has permission for gas installation ...,� .lr�s!.'�or ...... in the buildings of .. ���.... ......................... . at VAA 4$0 �4e.. ............ . North ndov r, Mass. � Fee. ,Ji�i S?? Lic. GAS INSPECT Check # 2//4/ 8145 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT # JOBSITE ADDRESS 13 r n OWNER'S NAME GOWNER ADDRESS UT A IO2rJ YU I TELF— :FAX - M R TPYPPENOT OCCUPANCY TYPECOMMERCIAL © EDUCATIONAL ® RESIDENTIAL CLEARLY NEWIR RENOVATION: a REPLACEMENT: © PLANS SUBMITTED: YES E] NOF APPLIANCES -1 --FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ^�� r BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER __j .. .. FIREPLACEI FRYOLATOR I Imo'ji FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS_A_( I - MAKEUP AIR UNITOVEN - POOL HEATER ROOM /SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER F INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES jINO n I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Rr OTHER TYPE INDEMNITY Q BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F AGENT F SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co Iia ce with all ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �'h %rPA,�ws ,,, LICENSE # 1 3 S GNATURE MP f �jt MGF D-1 JP El JGF LPGI [I CORPORATION Q# F------7 PARTNERSHIP [,1# LLC Fl# COMPANY NAME: _ �Cl1YtZr�P�----.--------� ADDRESS CITY Qy _ STATEMz1PE 'ELL- FAX CELL 746-17 MAIL i SM. ALN\ The Commonwealth of Massachusetts Deparbnent of Industrial Accidents Office ofInvestigations 600 Washington Street Boston, AM 02111 www.massgov/iia �licant Informafin„ - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/organizafion/Individual): — - - -- --- Address: ' City/State/Zip: f / /gr t Uva Phone #: C�7& r� Are you an employer? Check the appropriate box; 1 • El am a employer with 4. ❑ I am a general contractor and I employees (full and/orpart-time).*' have hired the sub -contractors 2. K] I am a sole proprietor or partner- listed on the attached sheet. T ship and have no employees These sub -:contractors have working for me in any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation and its required.] 3. ❑ am a homeowner doing officers have exercised their _I all work myself. [No workers' comp, right of exemption per MGL c. 152, § IN, and we have no insurance required.] t employees. [No workers' comp. insurance; required.] *PsY applicant that chec'.Ls box #1 must also fill out the tov T H section beim., aho;, eii ti, Type of project (required):' 6. (] New construction 7. [] Remodeling g..❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.ZPlumbing repairs or additions 12.❑ Roof repairs 13.❑ Other omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mels CUMP=- ust submit new affidavit indicating such. TContractors 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 in information. surance for my employees BeloN, is the policy and job site Insurance Company Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce /under the pat andpenalties ofperja;y that the information provided above is true and correct wim IL%i i iii Miii&:�ii Oficial use only. Do not write in this area, to be completed by city or town officiaL City or Town: PermitUcense Issuing Authority (circle one): 11 I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "'an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer., or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than -three apartments and who resides therein, or the occupant of the dwelling house' of.another_who-employs persons to -do _maintenance,.construction or -repair -work on such dwelling --house .-------- or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,' §25C(6) also states that "every state or local iicensing*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." "J. 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 cerdficate(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 anLLC or LLP does have employees, a policy is required. Be.advised that this affidavit maybe submitted.to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date -the affidavit. The affidavit should be retuned to the ci-tor town that the application n for the pet � ar" icen G- ie being e i fo' f ' t f �' F:ai` k_ bY�g r, araes.,4 not the D ar�eav o_ 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 ofEndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.1 Tel. # 617-727-4900 ext 406 or 1-8.77 MAS -SAFE Revised 5-26-05 Fax # 617-727-7749 �wvt�_rr► asc _ unufrT; a . Date ... �- -3../ — ../. Z.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... �ht 4- ........................ C has permission to perform ........... 5 &--r e, ................. ....... wiring in the building of ..... ......... rth Andover, at...... ,,-�o* "An**er',* 'Mass. Fee Lic. No . ............. ...........E4 iCA INSPECTOR Check # 1/77 10748 C.ontntonweald olVaaaack"eif_4 rfine 2epanf of3 ire Serviced BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. I� 741P Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR YTPEALL INFOT ON) Date: 21/ City or Town of: Mof* M(�1,), To the Inspector of Wires: By this application the undersigned gives noti/c�e of his or her intention to perform the electrical work described below. p Location (Street & Number) q 3 (')tPrt om)A ISN Owner or Tenant T� A � 00y KN Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Boa) Purpose of Building Utility Authorization No. Telephone No. - q tP9 Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install residential security system nuacn additional detail iI desired, or as required by the Inspector of Wires. I Estimated Value of Electr7ia4 l Work: (When required by municipal policy.) Work to Start: / ZZ 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 andpenaldes ofperjury, that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc. LIC. NO.: 7 0 2 4 C Licensee: Paul DelSignor Signature IC. NO.: 70240 (If applicable, enter "exempt" in the license number line.) us. Tel. No.: 8 8 8 - 2 2 - 9 2 8 2 Address: 22 Briarwood Drive, Westford, MA 01886 LkiAlt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. . SSC000 00969 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ (� t -111 wing,mote m be waived b the Ins ector o Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. o Total Transformers KVA No. of Luminaire Outlets - -1No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above Eln-❑ o. o mergency ig g rnd. nd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of DFtiition an Initiatin Devices No. of Ranges No. of Air Cond. Taos No. of Alerting Devices No. of Waste Disposers Heat mp Num .er Tons_ KW No. of e-Contame Totals: T---- Detection/Alertin Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Mumcipa ❑ Other Connection - No. of Dryers Heating Appliances KW ecuntyystems: � No. o Water Heaters KW No. of No. of No. of Devices or E uivalent Data Wiring: Si s Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcaaons inng No. of Devices or Equivalent OTHER: rN nuacn additional detail iI desired, or as required by the Inspector of Wires. I Estimated Value of Electr7ia4 l Work: (When required by municipal policy.) Work to Start: / ZZ 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 andpenaldes ofperjury, that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc. LIC. NO.: 7 0 2 4 C Licensee: Paul DelSignor Signature IC. NO.: 70240 (If applicable, enter "exempt" in the license number line.) us. Tel. No.: 8 8 8 - 2 2 - 9 2 8 2 Address: 22 Briarwood Drive, Westford, MA 01886 LkiAlt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. . SSC000 00969 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ (� t Y, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) : I,Ja" TfAeC+10 � A Q Address* �R y Mof-�q yi 1,J 2-S-f_�(N p K City/State/Zip: JClLQM, %% tl' o 30 ]� � Phone#:C� � o� o� 1 q 16 a Are you an employer? Check the appropriate box: 94 I am an employer with —1,15 4. ❑ I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. t required] 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions l l . ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. >QOther_S P ,' (5�5 how \Iot+a,3 e -Any applicant that checks box #I most also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contactors that check this box most attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If he sub -contractors have employees, they must provide their workers' comp. policy number. am an employer that is providing workers' compensation insurance for my employeeL Below is the policy and job site nformadon. 1 ( 1 nsurance Company Name: T D(A S C d. o 'olicy # or Self -ins. Lic. p — Gr 7 L A () `1 b Expiration Date:( Db Site Address: �I 7 an & �"� City/State/Zip: N(X-t� iY�01pJ�j _ � , 0 � b Q'i S ►hath a copy of the workers' compensation policy declaration page (showing the policy number and expiration (date). ailure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine p 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 ' 250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the SIA for coveraee verification. do herby cerdfp under the airs and penalties ofperjury that the information provided above is true and correct anature: ��� Date: l 0C f / I rint Name:�Phone #: U U ^ �O( — I V 'f,%icial use only Do not write in this area to be completed by city or town official ity or Town: Permit/license #: suing Authority (circle one): Board of Beath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other untact person: Phone #: ly Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... ........................... has permission to perform .............. ..................................... wiring in the building of ......... ................................ at ...... ................... North Andover, Mass. 4 Lic. No. ......g7... 4 ................ . .... ..... EL ATRIICA�LIN�spWrok- Check I= ...� _ The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): �; ��/��1 ��'� /�� /Q y Address:_ //i� �e�4.�L//J� _Z)p, City/State/Zip:-4oe?;;Kye�y / 1/, "16z 44 Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. [�rI am a employer with _ 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).` 2. E] I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # E] Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised their 10. [electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 11bother comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: 0 11!!�5 a,7e d / :76-7 Expiration Date: Job Site Address:/9%/�Z 6i O� City/State/Zip: ZV, A041 n12 1'e,oVV O/ � 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 certlo under the pains and penalties of perjury that the information provided above is true and correct. - Sidmature: �_�� Date• 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 Pers Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance f requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each. year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. .The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations AGO Washington Street Boston., MA 02111 Tel, # 617-727_4900 eyt 406 or 1.-877,7MASSAFB Revised 5-26-05 Fax # 617-727-7749 www.znass.goV1dia Commonwealth of Massachuset_ is offli�W Use Only Department of Fire S Permit No.Q p ervices BOARD OF FIRE PREVENTION REU91GULATIONS 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 (PLEASEPAWTININKOR TYPEALL.INFORMATION) Date:_ City or Town of: NORTH ANDOVER To the Is By this application the undersigned gives notice of his or her intention toyierform the Location (Street & Number) 7 L ---Z /0— n ' n 7 1 s' ,- -,) r 2'7 - 1 � of Wires: world described below. Owner or Tenant ®V:, Telephone No. Owner's Address e?��., 6 Is this permit in conjunction with a buil 'ng permit? Yes El Q' (Check Appropriate Box) Purpose of Building © Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters \' New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Y Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1�,'� /.ilf 47 Com letion o th:following table may be waived hy the Inspector of li No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA �(7 No. of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergency -Lighting nd. rnd. Batter Units No. of ReceptoAe Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No, of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons. KW "" No. of Self -Contained Totals: — Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems:*. No. of Water No. of No. No. of Devices or Equivalent Heaters KW of Signs Ballasts Data Wiring: No. of Devices orEquivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: - Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VERAGE: 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 cover.990 is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, underthe pains and enalties ofperjpry, that the information on this application is true and cow pl'ete. FIRM NAME: LIC. NO.: Licensee: Signature ve!� .: NO LTC (Ifapplicable, enter "exempt " in the license number line.) Bus. LIC NO Address: % a dl� Alt. Tel. No.: 'Per M.G.L c. 147, s. 57-61, security work requires De artment of Publie Safety "S" License- Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ G� _ JET cCTRXCA ]c'L-►PMTNO, IWREMON PORT. M�l Sailefl--j ]requzzed�($5O.OU) j j s:efore Signature -• 3RO tiaTs) Pate 2-NNAT,3N' CiYOW, Passea , aired--[ Re-inspectionrequired ($50.00)_ � nspectoxs' c ents- _ Y ftspectors° Signa Ts) gate 3, Elz�7nExD~OE.ND J�i�'EC5ZO�T: �'assed—j 1+aiied- j]Ze-frtseeiior��er�uirecT($50.0Q)�j ] 7nspectozs' C,3)nm.e)l (tnspectore Signatuze--+ao initials} Pate ,4 3 7SPEC110N—SER VOCE: Passed—[ ] �+'ailed--j � - �e-inspeetionxequiretT (�50AD) � j ) �spectbxs' eommep�fs: , (Xuspectozs',�iguaiuze Bio xnzfiaTs} Date f 'assed—[+aired [ ]. Re-inspectiottrequired ($50.00) -[) - aspectors, coviments: spectfors, Signatare,-.no:iuitials) date DDCE~ TA.GN .AM TO ON SITE W TiDEAMA To BE lNeECT`ED is NOT .A.CCESS)BIE .ABTA .A. RE-• SP ECTION ON 550,0 0 SN To 13F, CHARM. Ni The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address:_ l/i�i� 7�e G%/J� _4.3 g City/State/Zip:. 14,e2!��ee,oy &� p/by& Phone #: Are you an employer? Check the appropriate box: 1. [►"I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t" employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.Wlectrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ;' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lie. #:_ // � 0'e d / 76_j Expiration Date: M Add Job Site Address- %l _ Zt�3 /�.4�i9� rfJ i�0 Ci /State/Zi w , t3' P ZDOI/8�� %l OAF15 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 certto under the pains and penalties ofperjury that the information provided above is true and correct. Sip -nature: ���o Date• Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -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 (ifnecessary) 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 off dustrial Accidents Office of Investigations 600 Washington Street Boston, MA, 02111 T01, # 617-727,4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.80VIdia Date. . o4' TOWN OF NORTH AN VER ALL PERMIT FOR GAS�VW ALLATION This certifies that .. P. 1. (-.r. t, ... ... P..?l ...... has permission for gas installation tc. 5.......... . in the buildings of ... ............................. at . �-?. . � .!f . -n North Andover, Mass. Fee. :7 k — .. Lic. No./(., %. �. 3 .. .. . IA S INSPECT(aR Check# 5795 MASSACHUSETTS UNIFORM APPUCATON FOR PERNU TO DO GAS FrrnNG (Type or print) Date / /06 NORTH ANDOVER, MASSACHUSETTS Building Locations t9 q-� 64QUI T �����1 t --Eey r_� Owner's Name tj New ��jj' Renovation ❑ Replacement Plans Submitted ❑ Permit # S �� Amount $ 3 0— (Print or type) Rhvo �%)p V,� ff Name Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ElCorp. Partner. irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 . No � If you have checked yes, please ind a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond Q 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 13 Agent 13 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the hest of my knowledge and that all plumbing work and installations �performed under Permit Issued for this application will be in compliance with al] pertinent provisions of the IvIassachusilT7_Gas C an Chapter 142 of the General Laws. y: 'Title. City/Town VED (OFFICE USE ONLY) S' nature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Number n gaster r7r uurneyrnan 1111111111111111 Im1w 17TH. FLOOR (Print or type) Rhvo �%)p V,� ff Name Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company ElCorp. Partner. irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 . No � If you have checked yes, please ind a the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond Q 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 13 Agent 13 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the hest of my knowledge and that all plumbing work and installations �performed under Permit Issued for this application will be in compliance with al] pertinent provisions of the IvIassachusilT7_Gas C an Chapter 142 of the General Laws. y: 'Title. City/Town VED (OFFICE USE ONLY) S' nature of Licensed Plumber Or Gas Fitter Plumber Gas Fitter License Number n gaster r7r uurneyrnan el Date.off/-.9 - v.......... TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION.. ,SgACNUSEt This certifies that. ........... . has permission for gas installation .#./.3 ...................... in the buildings of . A, z/... i•.; ....................... at ... !�.1. ? .. l? u. ( I — .. r ...... , North Andover, Mass. Fee.. �� .... Lic. No.. ' ....... GASINSPECTOR Check # 5 8 LI 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) N. - GU&Q Mass. Date Permit # Building Location Owner's Name `Vc,4 Type of Occupancy_% G 0 - I New p Renovation p Replacement [R--- Plans Submitted: Yesp ` No p Installing Company Name /.,� C /`T� Check one: .,. , _ B—Corporation Name of Ucensed Plumber or Gas Fitter Certificate # — JrC 1 hereby certify that all of the details and inlormation 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 the permit Issued for this application will be In compliance with ali pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene al Laws. T e of Ucense: Title Plumber r u e o c nse lumber or Gas Fitter aster 3 y7� aster Ucense tJumber City/Town Journeyman i MENEEMEMENE NEON MENEM :NMI A MEMERNMERE Elmo MENEM, NMI ENEEMEMENNEINE MEN MEN MEN Installing Company Name /.,� C /`T� Check one: .,. , _ B—Corporation Name of Ucensed Plumber or Gas Fitter Certificate # — JrC 1 hereby certify that all of the details and inlormation 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 the permit Issued for this application will be In compliance with ali pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene al Laws. T e of Ucense: Title Plumber r u e o c nse lumber or Gas Fitter aster 3 y7� aster Ucense tJumber City/Town Journeyman Date.2.-, .- - IV -3 .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUS Et /---) ---,) - I r This certifies that ........ �. -.-,a .. .............. V./. .......................................... has permission to perform---..,:-) . . ............... ..... ............................ wiring in the building of ................................. at ......... ............... ......... . No Andover, Mass. Fee...................... Lic. No.............. ............... . .................... �ELECTRICAL INSPECTOR Check # 4740 THE COMMONWEALTH OFMAS94CHUSE77S Office Use only DEPARTA1Ua0FPUX1CS4FE7Y Permit No. BOARDOFFIREPREVENT ONREGULAT ONS527CNIRl2:010 Occupancy & Fees Checked 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 -� Town of North Andover To the Inspector of Wire; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Q) A/3 45-,LZI-�1. QZ�e r9. i.6 Owner or Tenant (1qP Ye--- cL'�- Ck (A Owner's Address si f1,..c —. 0--S Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) Purpose of Building (� Utility Authorization No. _ Existing Service .Lnu Amps / of Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 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 LocalMunicipal Other 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 OTHER /ii o% 1 p L i u �i` �, i t / /IS' C1,111 hlsttre=Covtrdg-- RustOltothemgmm=NofNbmdusoItsGemWI-aws Ihave aamaltLiabildyh PblicyinchxhngCmplue Opwehons ComageorilssulsuibaloWvakA YES E] NO Ihavesubn>iedvalidploofofsametodroffm YESffyfluba,&drdodYES,plmeirdawtbrMmofcowrWby dwkiIgthe box E INSURANCE BOND Or1iIER [D (Plea9eSpeafy) Fxpn-ationD& EsturtatedVa1wofEkfiicalWolk$ . WOIktoStat htspecttorlD&>ERegttesLod Rough Feral Signed underlie Realties Of petjW FIRMNAIVIE i t� P Ul/C G: cry L t IictseNo. SA s „i i2 licensee Sigrlattue YLiomseNo ! Z' c -:T1,1 BusrmTelNo. "fl-?) I -jj" Arlrh�ec O� G `ic{{¢ e9 ts'�- (P -Aa x..14 A Alt Tel No. OWNER'SINSURANCEWAIVER Iamawaredvitirl-k Se-doesnothave theirm>MnX0Dvaageoritswbstantialequiva1attasle#tedbyMa%adIuseasGcwdLaws and that my signahm on this pemnt application waives this requnerrtatt (Please check one) Owner Agent j Telephone No. PERMTr FEE $� signature o - wner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Massa 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 rry employees working on this job. Company name: ' Address City. Phone #. Insurance. Co. Policy # Company name: Address Ci!y: Phone # Insurance Co. ___ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonmentas weU-as_civil.penal iesinlheinuntfa�STOP1l.V.ORK ORDFRand_a.fne_d.($1AO.DD)_arlayagainstme l understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. / do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept E] Check if immediate response is required .0 Licensing Board ❑ Selectman's OlfcE Contact person: Phone #. ❑ Health Departmen Other Location c y)4/3 No.6 Date MORTM TOWN OF NORTH ANDOVER OL Certificate of Occupancy $ cam.► <«:.'�... `', C../ VC �� y' s�cHusEt� Building/Frame Permit Fee $ . , Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # 3 OS 15L37 'M M, t Coe. -v`" building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING NR Y,>rs"=, '` ryThis Section for Official Use Onl r a BUILDING PERMIT NUMBERS �y 6 DATE ISSUED: I Al �� SIGNATURE: ze BuildinA Commissioner/I or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number. l �JZoningInformation: Map Number Parcel Numbs 1.33 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provides 1.7 Water Supply M.GI-C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 00 Private 0 zone Outside Flood Zone 0 Municipal On Site Disposal System 0 y� 2.1 Owner of Record /' S V �jp/t1��� � ►t l�%99�C,C/LI�jF�% 'm and wr )onyt Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Telephone ,Signature 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number s.�orhl/ ,ed', xke4 kl'*�aj(y, rte. oi-'6y (a lz�Azs Licensed Construction Supervisor: Expiration Wte Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ �u�l�it/ �jc�lQ��ti1yG G�o�s:• Ca. /D Company Name,_ Registration Number I?CW JAI U A4, 0/9 Address r �_ Expiration to ignature Te hone v D M 0 M Z 0 Z M 0 n ic r v M Z G) L G,b Pini e as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury � G lyl int Na e Z 9176r/ Signature of Owner/Agent 13ate Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number 4",, t. r.2C}:?'J}S �`-{ �v`.. �y �f � �'h t �.: t" x. y 1 i .; JJP'{'�+ t�tS �� u.'t U�/. `t' ,.�'.•T,S '.. f �, 741 t'.a` f-i^>r.,,F 4 °^ yu �3[5{v tit^.,{�2 h_Y 1. h jl"� {,: Lt>b f fi. .• � ,.�nt?f(� C n.°s,':.2'x���?!s;kY..'`.r'�yd,r..�-ti',;�r;`'z w'4�.�`tt'',r=.,k' t "��S' .5 �)r,i�7�'.>•3 } trt{ t �, s�s'r�?�,��'"�+�.:,e�`�4' €.��-�t�s : �,.j,� .a •n,�.,,J t f - f a^�zf:xa�.. NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2ND 3P SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHUMMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE '^� `&. go. 5.• � h_<'-�.., .'� 5 > .�- > .'. .... _ ,.. ,.:. i. +.,f-'._ ._� c.. .::- -r c - ..sro�tx.-.K. ,� o^"l_,n... S ._k. ,.5�,� ,!. i New Construction ❑ Existing Building ❑ Repair(s) e Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: +m lG Uel' Gwgalc or e - 4"a / Can eA ❑ ❑ B Business ❑ 2A 2B 2C Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner - Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ IA 113 ❑ ❑ B Business ❑ 2A 2B 2C ❑ ❑ ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ residential ❑ R-1 11R-2 ❑ R-3 ❑ 5A 5B ElR ❑ S Storage ❑ S-1 11 S-2 ❑ U Utility ❑ M Mixed Use ❑ S Special Use ❑ Specify: Specify: Specify ; COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: '9!r_ S i Pee wT ec Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: m , NEW BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement .levels , C , Floor Area per Floors , Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Reqwred Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner - Date Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea ....... IT' No ....... ❑ 5.1 Registered Architect: Name: .Address Signature Telephone Company Name: Responsible in Charge of Construction Not Applicable ❑ Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ _ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Company Name: Responsible in Charge of Construction Not Applicable ❑ FROM : ATA FAX NO. : 9766643364 Sep. 17 2001 01:14PM P1 ATA BUILDING & REMODELING CONSTRUCTION CO. 42 Tower Hill Rd. North Reading Ma. 01864 FAX COVER SHEET DATE: 9/17/01 TIME: TO: BUJI DING DEPARTMENT PHONE: 978-688-9545 FAX: 97&688-9342 FROM: TOM ANGEL) PHONE: 978-864-3364 ATA Building & Remodeling FAx: 978-664-3364 RE: UPDATE INFO FOR DEPT Number of pages including cover sheet: Message ' Piease Find Copies of Workers Compensation AfOdav#, &licensing information for Thomas Angeli ATA BUILDING & REMODELING CONSTRUCTION CO. North Reading MA. 01864 Th��u Tom Anger FROM : ATA FAX NO. : 9786643364 Sep. 17 2001 01:16PM P3 (�, ' _' �� -���w•aa•rrrea/.d�a�../�umaaa�ereeAa 1 =_ BOARD OF BUILDING REGULATIONS v'.Clcense:.CONSTRUCTION SUPERVISOR Number. CS 043773 8irth�'06/07/1957 1 ftpir"...Q /07ko03 Tr. no: 10823 . F Restricted y, THOMAS P ANGELI,_,// 42 TOWER HILI. RD T� ;N REAOJNG, MA- 018$4 Adrtlinisbr6tor' '.:: �e �rr�xrae�lU a�°.�faaoac%use!!d . .f Board of Binding Regulation aad Stmyiuds ' • HOME IMPROVEMENT CONTRACTOR Registration: 107523 I EXPIratlon: 08!04/2002 ;. Type:. DBA ATA BUILDING B.REMOO.'CONST •` Thomas Angell 42 Tower Hill Rd N Reading, MA 01864 Adminislzator _ i Building and Remodeling, Construction Company MASSACHUSETTS BUILDING COMMISSIONERS AND o, INS79CTORS ASSOCIATION, INC. 7vz; I5 to cetrlfy shat chdow Thomas P. Angeli is an associate member vii duo paid ru Sop[embar �. 1999 Treasurer 42 Tower Hill Road Tom AngeU, Prop. North Reading, MA 01864 (508) 664-3364 FROM : ATA FAX NO. : 9786643364 Tlie Coinrnonivealth of Massachusetts Department of Industrial Accidents mce,011fl esliyRaefls 600 Washington Street Boston, Masi-. 02m Sep. 17 2001 01:15PM P2 C) I am a homeowner performing all work myself_ a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. =DAL y{s tale^ : ihcn rstnrrrn!.'-.7.'�'f��.'J.: s+.�ll�lzS:�/1/�t�/rJ.�itl /I I.Y!!i/� ..r:,..,sr^�.: _.,fes:/a�•%.•f�•��!'.l�Y"/'' . © I arra a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: F:+ilure'to secure coverage as required under Section 25A of.MGL 152 can lead to the imposition of criminal penalties uta Gdlc up to S1.500.00 and/or one years' imprisonment as well as civil penalties in [be form ofa STOP }YORK ORDER and a rine ofS100.00 a day against me. i understand that a copy of Ibis statement may be forwarded to the Of ce or tavr4tigations of the DIA for co,erage verification. / rfo hereby crrtijy under h4 pains an8�e les of parjvey thetr the iuformalion provided above is true an el correct �de . Signature i�- ,. Date Printnamt l% .�¢-!Li I'honcg7 Zit y orfdcial use only do not -rite in shin area to be completed by city or town official . .. city or town! permit/license d nBuilding Department dL3censing'Board 0 eneek if immediate response is required 0sclectmen's Orncc OIiealth Department eoatact person: phone k; __ nOther ' � ✓%� t!nnrrnanrr�l�z a� _ iltzucz�/u�,tellj Hoard of Building Regulations and Standards ' { HOME IMPROVEMENT CONTRACTOR � x� Registration: 107523 Expiration: 08/04/2002 Type: DBA ATA BUILDING & REMOD. CONST Thomas Angeli j 42 Tower Hill Rd�,,o fj N Reading, MA 01864 Administrator j ✓/is `��»z»casu�,rrfl!% a�✓��rra.�ac�{tareQ' + BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 043773 Birthdate: 06/07/1957 Expires: 06/07/2003 Tr. no: 10823 Restricted To: 00 THOMAS P ANGELI 42 TOWER HILL RD 3 I1 II II II LINE OF: BEA l G IN CLG. OF G,2E, J ROOM BELOW If II II I 4X6 POSTS FtOm ROOf= 70 HEADER I CEILING BELOW x1b �x 4 VENTING SKYLIGI5� m D —HALF 1114LL Y RAILING b r b1f- QN !F - HALF WALL 03 LINE 0t- CLG. BONUS ZM UNFINII/lIE6\, �0, ATTIC STAIR b AX6 rs 5'-119/16* IG -5 3/8' LINE OF MG. ABOVE 6 6 DIN vv L C. DIN 4 S L A\E ABOVE / 4X6 POST 07 / fFPl2OVlDE-CATH4MWQAkL P12OVIDE7-6*X4!-6' CLG. IN HAI _IWAI ACCESS PANEL 5' PIC44 KNEEWALL STORAG LWINISILIED _7 ROUGH IN FOR FUTUE E1141�41 �t A mi v 7� cz w A � O u O v ® CIO Z z A „� a Or. O O u ,', U x G p w' C W. a o W � U W p C x U w z ¢ p G z �. A w P-4 ° cn Q ° cn c o C V O • C N _O c �. O V c.3 d c CO y 1 O c y CD E Q O CD �► �: CD�p : o CL r y Al .D E� cm�E H CD ce v I y O i� _� O `m o C act m Qf .� Co Of c y c Z O CD eo o cm CL Q y m c o N � O ZA us o.rc z0 �E ca y O C3 .m ca o o� ~ a o30 � O� 2 Z Q y'� O F- 0 z O u Cf) r� 0 El 0 42 CO O� I Cl CD Ln CD E m CD 0 CD 3.0 a� CL Ca y C O.6-9 C ccco C CL o CD C Z ts ai CL C-7 V3 !c C C— a is 1 0 U) vl w w w N° If7 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... �. • • c �.�• �- `'t • �I• ............ • 91 has permission to perform .. I^: t4. �.�.'.`'. �... ......_...... • . • .. . plumbing in the buildings of . �.;..: ? `...................... at. .(.. .4 .`.`.......... , North Andover, Mass. Fee.Lic. No .......... ............................. . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO DO PLUMBING (Print or Type) As Date C, t�► 2001 '3P���x ra ass;. ' Permit # Building( Owner's AT: Location 13H3 - �� ��jy�!� k),- • Name Type'.of Occupancy: New ❑ Renovati-on ❑ Replacement ❑ Plans ❑ FIXTURES Submitted: Yes ❑ No (Print or Type) Check One: Certificate Itlsta.1ing Cont an 1 Name ' ,� + r7 i� � r �� � � Q Corp. Address 3.08 Maih'�StreetG�`b�i�laritl�t�a�� �' `t ����,.�"���'�P�ri�lifa.' x , w. ,,. �u. a,.: ❑ Partnership ❑ Firm/Company Business Telephone 978 % 2-12 � . " �� Name of Licensed Plumber or GasGtter 1 hereby certify that aU of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Sipmule of Oww, Acetal I have a current tiabiGty insurance poUcy to include completed operations coverage. ❑ By Sig r o Litxns Plum Title City/Town 11,427 `; Type of Plumbing License •'�""' "" ''� ��" `` X Master [I Journeyman APPROVED (OFFICE use ONLY) License Number Y• • • ■rrrrr■■' t : ■rrrrrrrrrrrrrrNMI ■rrrrrrrrrrrrrrrrrrrrrrrrrr�r .. - ■rrrrrrrrrrrrrrrrrrrrrrrrrr■ '•••arnrarrrrrrrrrrrrrrrrrrrrrr■ .. .. ■rrrrrrrrrrrrrrrrrrrrrrrrrr■ •••■rrrrrrrrrrrrrr■®rrrrrrrrrr■ t •••■rrrrrrrrrrrrrrrrrrrrrrrrrr■ •••■rrrrr■®rrrrrrrrrrrrrrrrrrr■ ...■rrrrrrrrrrrrrrr■ ■rrrrrrrrr■ ...■rrrrrrrrrrrrrrrrrrrrrrrrrr■ (Print or Type) Check One: Certificate Itlsta.1ing Cont an 1 Name ' ,� + r7 i� � r �� � � Q Corp. Address 3.08 Maih'�StreetG�`b�i�laritl�t�a�� �' `t ����,.�"���'�P�ri�lifa.' x , w. ,,. �u. a,.: ❑ Partnership ❑ Firm/Company Business Telephone 978 % 2-12 � . " �� Name of Licensed Plumber or GasGtter 1 hereby certify that aU of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. 1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Sipmule of Oww, Acetal I have a current tiabiGty insurance poUcy to include completed operations coverage. ❑ By Sig r o Litxns Plum Title City/Town 11,427 `; Type of Plumbing License •'�""' "" ''� ��" `` X Master [I Journeyman APPROVED (OFFICE use ONLY) License Number TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ .......... has permission to perform ) ........................................... wiring in the building of ...... f� ............ . North Andover, Mass. ........................ .... ....... Lic. No! .��/'--. ...... .............................. ELECTRICAL INSPECTOR Check # r - d '6W" 9; 'i f I Commonwealth of Massadhusetts Department of Fire Si ices BOARD OF FIRE PREVENTIONAEGULATIONS APPLICATION FOR P All work to be performed in ace (PLEASE PRINT IN INK OR TYPE A LL,,W1 City or Town o By this application the undersi d gives notice Location (Street & Number) Owner or Tenant Owner's Address Official Use Only Permit No. 5-yF1 Occupancy and Fee Checked [Rev. 11/99] leave blank) IIT TO PERFORM ELECTRICAL WORK with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 WA TION) Date: g%(,P_� To the Inspector of Wires: pr her intentiog'fb perform.tlije electrical work described below. Is this permit in conjunction with a.buildingpermit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work: Telephone No. Yes.[T. No (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters _ Overhead ❑ Undgrd ❑ No. of Meters Installation of Security system ('mmn7ptinn nftho 11)77nwina tnhle mnv hp wnivpd by the fncnortnr nfWiroc 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 Units . Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection andInitiating Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers . -_ _... Heat Pump Totals: ,Number TonsKW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers.. Space/Area Heating KW Local ❑ Municipal [I Other Connection No. of Dryers rY Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Kms, 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: Attacn aaauronat aerau g aestrea, or as requirea oy me tnspeaur uj r. �.— 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 El BOND F-1OTHER El (Specify:) (Expiration Date) Estimated Value of Electrrical Wor : (When required by municipal policy.) Work to Start: /" -�l9 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 1 q11(' 1(' Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: I Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid, 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: $ Signature Telephone No. F Location y 3 (, R eckt" Po nck 12a No. —S -9r Fl me- Date CHUStt 950 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ��"20 Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works Location No. `� Date �2A VC, MpRTM TOWN OF NORTH ANDOVER. o ; Certificate of Occupancy $ 49 Building/Frame Permit Fee $ Foundation Permit Fee $ ' Other Permit Fee Sewer Connection Fee Water Connection Fee TOTAL $ /sem $ B Ing Insefitor Div. Pubric vvorKS Location -24-3 6,2,M -T No. Date 1z q n; NORTH TOWN OF NORTH ANDOVER , �Ot t. `D ••MO 0. Certificate of Occupancy $ Building/Frame Permit Fee $ E �'�s°'•"°'�' sAcHus Foundation Permit Fee $ J by AC -A Permit Fee $ Sewer Connection Fee $ " Water Connection Fee $ TOTAL $ S� (� Building Inspector 7819 Div. Public Works PERMIT NO. U APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. I 4 2 RECORD OF OWNERSHIP iDATE BOOK :PAGE ZONE- SUB DIV. LOT NO. LOCATION 9.3 C A e46Vj ,I V URPOSE OF BUILDING �/% s vS•IZE OWNER'S NAMEJW,I L A i CC, NO. OF STORIES �, _ e� a /l�Q � LRJ JlA I� {V OWNER'S ADDRESS ��� ♦` g$a fQ ASEMENT R SLAB A'RCHITECT'S NAME . ♦ SIZE OF FLOOR TIMBERS 1ST.L Irt /D 2ND y /!1 3RD A L L� aU BUILDER'S NAME m SPAN /Ir� DISTANCE TO NEAREST BUILDING /� � DIMENSIONS OF SILLS ('o POSTS c 'q.� sic DISTANCE FROM STREET / Cco O DISTANCE FROM LOT LINES — SIDES 17 f12 REAR GIRDERS AREA OF LOT .2 FRONTAGE f00� �D (( HEIGHT OF FOUNDATION Q THICKNESS [ IS BUILDING NEW Gr '7D SIZE OF FOOTING /� X zQ IS BUILDING ADDITION MATERIAL OF CHIMNEY 2�C IS BUILDING ALTERATIONf� IS BUILDING O SOLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE dl S IS BUILDING CONNECTED TO TOWN WATER �S S c^/ BOARD OF APPEALS ACTION. IF ANY D./AG �j IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE �s INSTRUCTIONS PERMIT FOR FOUNDATION ON SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.�,. PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 DATE l FEE PAID. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING p't ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS V PLANS MUST BE FILED AND APPROVED BY BUILDING INSPE TOR DATE FILED /7j —/¢ — .1!4- w a S SIGNATURE OF OWNER OR AUTHORIZED AGENT `F E E Zo in PERMIT FOR FRAME/BUILDING S�.00 e o PERMIT GRANTED 19 DATE: ti 1 4v FEE PAID•. I DEC tZ N4 RK PFRV FIM" Zo 011 FRWE f 3 PROfjERTY INFORMATION LAND COST �+ t✓ tO EST. BLDG. COST V 37 f OC:� EST. BLDG. COST PER SQ. FT-& � s EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY OWNER TEL# CONTR. TEL. # CONTR. LIC. # H.I.C. # p - F BUILDING RECORD 1 OCCUPANCY 12 ` SINGLE FAMILY MULTI. FAMILY STORIES OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION CONCRETE �I CONCRETE BL'K. BRICK OR STONE PIERS _ 8 INTERIOR 3 PINE P PLASTER DRY WALL UNFIN. FINISH 1 2 ( 3 _ re7++ BASEMENT A FULL FIN. B M ' AREA '/p '/. FIN. ATTIC AREA _ NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDS CONCRETE EARTH HARD",/ D 1 2 3 �_ _ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONR STUCCO ON FRAME I _ commcu [{ "y � BRICK ONL M—A�Q RAY BRICK IZFf�i�.'1 ATTIC STRS. & FLOOR CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME -ADEQUATE I� ONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX. GAMBQEL MANSARD TOILET RM. 12 FIX.1 FLAT SHED — WATER CLOSET ASPHALT SHINGLES _ LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL _ STALL SHOWER ROLL ROOFING _ MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM jA STEEL BMS. & COLS. HOT W T'R OR VAPOR WOOD RAFTERS AIR CONDIT70NING oop _ RADIANT H'T'G UNIT HEATERS GOAilL 7 JI NO. OFjqOMS B'M' 2nd _ I., I 3rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM. LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS,REPLACES PLOT PLAN. •� i .• '�F�Iiul� I � ea 3%,M Tom,� 331-10„�.�...r.� S 293 6eWT eksluo -RAC, -Z AUJU • err_ a7 N �cIms fcrz- Sk- I:t�sptMek1 �1- Sr fit' C,,Mgtajo� oRL VRAMM46 14 r-1 h W s•: w A xC/) bG O w° Q. U) cz O z z c� zOC E—cu Z w° Q .0 U G w U 7 id w O W W ' cn w v� dO A C ii W W Q w v W cin -� O cn LU o � EQ o a �Ey c CDs E tAL Oiwr 4. CD c� c � o� o * 7 N O1 N O O .�• N V: E O J C-2 m O Q Q cNQ 04 � o cow m 4' w HZ c G o c _CDn Q y O C •O = m 04-m N � _N nsOC Z LLI CM CD CD L3 4D COD n CD g = w m v O y 1� t r Mo..m :IN ' E o c "r 1� C � V: c O V d: VO • dO A � ^' Cmc o CO) � v Q'r o � EQ o a �Ey c CDs E tAL Oiwr 4. 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A.t/ODYE.� �1.4S.�4Gf/l/SETT.S O/B/O ..T71-� r .^ \ / ZO'0 3534�� -a �3 ���• Poi 1 / Z A",Ear cE.cTiFY ro T.yE ;-iTe�- /,VX&,,en,C.4VO RL or Rz, 4-V %t% %/ ---B•¢A/•r M-47 T,foEOwE-Z41AW If LOCATED VV T//E LOT.4S-%W,0ry A.VO rAM4T/-,PAM5' CO.1/FOelw /IV lY/T/1 T/1E *ew- • OF AV A.100 Vt,C Z01-I'lN6 zeamdAT.b,Ns iQL�6.•IR0/.Lis' sETEi/C.t's F�DAf sTPEET,S f LOT U.wE3: '' �.�T,4! /9�4/OO vE',� j �A S,5• S F(/,n-y� LE.rT/FY T.L'AT T•s'/s OA►2rCL�N6 /S �vOT e�ewo"V -oe LOG4TE0 /� THE FEOE.PAG iiCA00 H•4T4C0 APER. I.S-fd -V O/V CeMA'=�OMMt/N/TY PANCL �O6Elr4�/ 2SUD�8i �oC �EALTY �Oe/o � RL. S. GATE H ��F3pt�v .. �/OT FO.P Boallo,Py BOUNOA.PY /�(/FOiQil!- /NE�•P�itl.9Gt� E�VG/.�/EE,P/.f/6 SE.Pf�/lES Ar�vv r.4.r /srivc .�Ecoeos. 6G �.4.P,(� ..ST.rEET A.t/OOYE.� /y1'4S•S.4�f/!/SE7TS O/8/O FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. APPLICANT: Q LOCATION: Assessor' Subdivision �R�\ Street :ion***************** Phone �O�(o 94_I ( 2 8 Parcel Lots) ,t St. Number -�`Z 4-3 ************************Official Use Only************************ RECOMN�N AT N OF TOWN ENTS: Q Date Approved 12 l 6 Conservation Administrator Date Rejected Comments i ( vpw Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved 2 Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections fDgy9h SSbJ12hz714 � - driveway permit /155 Y.. Fire Department .,rte':?' GSC deft by B ��uilding Ins ector Date F \ � •,fir. '• -.. ` ' \ R 75 \ v\ 14 \ ,39X7.5 tib 1 ° ffij � � - ��, Yes oL \�, ��- / �� PREP P✓��N1N pee qV 12 2 q � 043 D 1 I 44 %— — - 17 G 40 iA 3 l 1 I 4 157.5 17.5 745 Z 5 - az1X4.4 ; d k4- -A i2 � : • ��� / _= / r i /� 11J ,'LSF � +�� (/✓ �- _ _ - - � ,tip--_ � fa � -/2 Ate _-- �-- �� I � • 'i :? g � �� axZ� / Kv ow 14 '4AA �cz A-aq IJ 44 150 .,✓' ,ss. I 4 i plo � I ��� • PKoP. �,F�'.S/off/ _ - - 4j Aq 10 V 1�14-4 , I //34 K p14Z'�/c A'tl ' 13 -A �C 132^A° kv 19 • r _ A.5 00 _ 2 /o -�� 8'3 1 \ \ .39X7.5 � I �� t5n � -j ' \' •` \ ist 1 \a'} )Cry 011 41 i I I +tip ��► dos/off./ C'orvTrPoL � �� a � �� P 2,� � ave. st 4 -0 tfiv I1,4 � C • T � l� � II ' - ,,1 % _ ii 38 V iq 1 h I"93 �Zy �� •, �C-/c i. o a � /1G • u 1 � 175 45.75 � G 044 Z, c-. • �� 5� '` ;2�� _� ------ •` '• • lo3.9g - / � � • �¢ ' %� �" , ti� � ''�1 �,; -- -- .tip __ -------- 01 .4 , � q i • �"GAS � S � �,��/B7 �tv — 60 AJ.---- - - 4, 1!e qC 9 - COLLOPY ENGINEERING CONSULTANTS . 65 AYER STREET FRANCIS H. COLLOPY REG. PROFESSIONAL ENGINEER Building Inspector Town of North Andover North Andover, 14A 01845 Dear Building Inspector: METHUEN, MA 01844 CIVIL STRUCTURAL DYNAMICS March 8, 1995 Residence: (508) 685-7969 office: (508) 685-8069 Fax: N I am writing in regards to the new residential building under construction by Ridgeway Realty of North Andover at Lot 4, Great Pond Road, in North Andover. I inspected the project with the job supervisor, Mr. Richard Tobin, on Friday, March 3, 1995. In particular, I inspected the crack in the garage foundation wall which is located in the left rear corner of the garage. The location of the crack is at a location in the wall where the final grade of the soil on the inside of the wall and on the outside is approximately level(less than 1 foot difference in elevation). In its present condition, there is no substantial difference in lateral soil pressure. It appears that this crack was the result of improper backfilling on the inside of the garage without any equal soil pressure on the outside, and also was probably backfilled against "green" concrete. The existing crack should not effect the integrity of the wall if properly corrected. I have enclosed a sketch which shows the recommended fix so as to repair the existing crack and to provide a method of not allowing the crack to grow in the future. Under the existing and final grade elevations, there will be no lateral pressure which could cause the crack to open, or for other cracks to appear. It is my opinion that when properly corrected, the wall will be structurally sound to support the building as designed. If there are questions in this regard, please do not hesitate to call this Office. Sincerely, COLLOPY ENGINEERING CONSULTANTS Francis H. Collopy, P.E. Structural Engineer Enclosure cc: Richard Tobin COLLOPY ENGINEERING CONSULTANTS 65 Ayer Street METHUEN, MASSACHUSETTS 01844 (508) 685-8069 JOB 111DGF1k)4`( 7-CRL-T� e=-1.2 � SHEET NO. C OF F CALCULATED BY ✓ G DATE CHECKED BY DATE w"'-0"Qm 0-1 —,no f4 mme., WIN. NnSS. 05171. TO ONlr PHONE TOLL FREE IM225-M SCALE ............. _ rp �• ?. . + _ 072 EUcO . ...... N ...... . 2 3 3 wloe x 3�8 ST<- $r► . .............-T- S�LEV ..... I ............... ............. i-.......... .............. ,� i , .... ... ......:.. STI TG f{. �+✓p-/'1.;. ,, , ........ ,. V r-197 T T- `. VIA Nor...' 7G:AG,E�J%vT ........... 1.�SN�p�D $�Pj�c�B7S :.... /.+. _ .... )4-7 2 G l B.. ...... r . 1. VTTTT.&-L�� ��v kj "-++- -1-1 -T- I --T-:11 0- ll L 1- - ETTE] J T! T -Tj w"'-0"Qm 0-1 —,no f4 mme., WIN. NnSS. 05171. TO ONlr PHONE TOLL FREE IM225-M 85131/1995 13:45 6172794448 MZO GROUP PAGE 82 MIA UELLE M.Z.®. GROUP p,Miect Ridgeway Lot 4 Great Pond Road No. Andover, MA so i • 131101;14) a4-'Z'l8 .� ter► _.sir � � D=1131195 Tme:8,10A.M. I&a&er: Sunny .: 70 degrees Present at Site:. David O'Sullivan, MZO. Architectural Group; Hen Osgood & Ben Osgod Jr., Evergreen Management; 1. Lot 4 - The roof is on house, the windows and doors are installed, misc. framing remaining. Exterior trim and siding is installed except for some window trim and area around front door. Observations: Ldt_4 1. Install steel angle, 3 by 3.5 high by 318 tk. lagged to column at living to better support microlam running front to back. I 2. Hangers needed at roof rafters of front dormer of bonus room. 3, Header needed with post to ridge over door to bonus room/rear stair. 4. Continue post in rear wall of rear stair to foundation. 5. Post missing from ridge to ceiling of study, double ceiling joist should be triple. 6. Post needed under microlam g side dormer of front bedroom. 7. Continue flat ceiling into front downer to provide area for insulation. S. Microlam beam at foyer ceiling needs additional 2x4 °s under it continous to foundation. 9. Check headroom at basement stair when it is built, additional 2x6 joist may need to be put in place of 2x1O's as per plan. 10. Provide support in basement floor for post in corner of master bath above. 11. Provide steel plates under beams in foundation walls at beam pockets. `12. Provide post at corner on basement stair platform to align with post from roof above. 13. Triple header at basement stair not built in correct place. Cut out section of floor framing to provide for step down to landing and support edge of stair openin ring wall to slab. 14. Exterior- check for Proper cricket at roof over m.bed EO ARe RFApst% David H. O'Sullivan Vice President, M.Z.O. Archite M.Z.O. 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