Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 25 COMMERCE WAY 4/30/2018 (15)
CD � f � � if V� '"A Location n t r Nod Come, 2 Date 7A�, Z2 -2<.-1 ki TOWN OF NORTH ANDOVER Certificate of Occupancy $ <�- Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # ( ( Uy a� a� �;>0 Building Inspector i !00 k V A � Z Q C. N N 4) C) z A C) o a p `^2 od Q W m Cl) t: m LL z I Lu Q � U. W V CO t 2 k � A U N N � � z A a a `^2 r CO rn N W� d M H z io rn 0 H z� E z E U aw a 2 o z M%9 0 1 O < f� p c C9 �C CD C O O.� pp . v .. u O N y m 3 = ,gym � c c o E / 40 A m `O cm ® • Q �: dJ O O �■ C3.5 z O cc O cm r C COO c d Q � y m c •O = m O 30 N H y H C . H d oLLJ ea C Z LU E 8 a H o C3 a g _ v a ` vi.= o H .c 8 a m 0 W. d .. x: x o- � !7 w \ v L� u cn m O v w/) 0 U w" iii w t�. a O as cn cC/)O 0 1 O < f� p c C9 �C CD C O O.� pp . v .. u O N y m 3 = ,gym � c c o E / 40 A m `O cm ® • Q �: dJ O O �■ C3.5 z O cc O cm r C COO c d Q � y m c •O = m O 30 N H y H C . H d oLLJ ea C Z LU E 8 a H o C3 a g _ v a ` vi.= o H .c 8 a m 0 W. d Location 0 ,'5--(bPu lfPcE LVA �( No. a S -o % Date/ --31-0a)1 Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee 51,3 0 $ TOTAL $ a ✓ Building Inspector Rodndy Benn Tel. 207-774-2843 Ext. 102 rodneyb@baileysign.com 9 Thomas Drive Col. Westbrook Executive Park Westbrook, ME 04092 1 -800 -539 -SIGN • www.baileysign.com • Fax: 207-774-1193 Established 1975 A � bA O U t U o � y � O bA O � � b � •� . ai -b N �N i �Mo1 ,� * W • � "d O 04 ^ (uo eo G «3 vi O a,• F+ � 44) o ++ O • • o o o c H U � vi " A *9 o � C's � bA O U SIGN PERMIT WORKSHEET Property Owner i/ Y M C Business Name S4 �,kl L,L�- Property Owner Address �/? C, Sign Location Address Zoning District Allowed Area %69, Proposed Area Allowed Height Proposed Height 4 Allowed Setback A0 Proposed Setback Map Lot Estimated Cost $ Fee $ Permit Application Received Iz 0, — C Permit Approved / RMOS Inspector v /V m I RS _C E C M J = C = � E T_ 0 X Z c W C 0 (T3 C r J E O S' E ll.! O f4 L m O�c�N°' a) c O 0.0 o 0 Q Z U »- Qcu J C _ � U C: ¢ O CL Q Z cni O O L1 m L No�ca--- V) O W LTJ L C O 0 a� 0 0 0 Z4. 0 �. U c� L �a0u)'°c O 2 'Oca U ~ Cl) N m I RS _C E C M J = C = � E T_ 0 X Z c W C 0 (T3 C r J E O S' L m U "O f4 L m O�c�N°' a) c m c 0.0 o � o-ocEa�ic�.o cn - c �- C (0 .0 O O U N S C: UJ C C Rf NQ � C C E0) cni O O L1 m C 2)= (n No�ca--- V) U CU � Co O >+L LTJ L C O 0 a� 0 0 0 bc 0 �. U c� L �a0u)'°c c a c 'Oca U O p N C cO c6 m C L N a O L O Q 0O �i - O L a o E a tts .Q U 7) C E O S' L m U "O f4 L m O�c�N°' a) c m c 0.0 o � o-ocEa�ic�.o cn - c �- C (0 .0 O O U _ U) C S C: UJ C C Rf CU U m U Q C C E0) cni O O L1 m C 2)= (n No�ca--- V) U CU � Co O >+L LTJ L C O 0 a� 0 0 0 E o 0 �. U c� L �a0u)'°c Q a c 'Oca U C (0 a= O Q� to O RS N C cO E CO m C L N a O L O Q c C N to O O Z/c� o - O L a o E a CC CL U O n O 0) L) CL C O •� (B O C U) U C 0Q L C m Z (4 O Cn m C N c c� cn a� O CL O_ i U C N Q 0 O E m Z ui a� 0 W CL W U W m Z J J O F- U IL d w .J Q. O Z Q J EZ W Q 0 co Q co E N N L c V) c c a� 0 c� o 'O C E V) U � 4- o p N 'S N CC CL U O n O m C N c c� cn a� O CL O_ i U C N Q 0 O E m Z ui a� 0 W CL W U W m Z J J O F- U IL d w .J Q. O Z Q J EZ W Q 0 co Q co E N N h \ R P S � �+`..�rry nrw+t• f. ii `i'�k7ik'T+ i�- A ?^.� z `/)' V J i% rri 44 14 10 m C-1 -5` •4 I 5 � Ai ' � 9,, . i i ; �' � s ti Z � �► m ~ m 4� i� •- r % i i' Z C y r ' m Z � tM=*9106 0 n m r +a tit p k _ � 1 4 e `?jt f f lt;7 .ac u v p T! O Q (D 4� AA n p Z a p O? m m C OR t T._ ♦ re+. } '} 0 t x t i { 4> t - t73 i..2 ::` { '` U111e, u - x a SCALE P.S. # CLIENT D D z z O v>,znC" oo mci D? REVISIONS: G D M O m 4 m -V D �O MM �Szgm o0 oZo ov, D m O v8 O m m M y Z O m m 1�mCn a= .0 co, �v D m v D _ D N �l% m 7o D fTl -=1 Oz N n Oz z ZMMM--T-i =� oo�v zo Z ■ o m O O O V N Z> 3M-N c2 D>2 Om Z z Z O a O O DWn�z �� mmpm mfi, O Bale O T 0 z z Z a �oo9� �m m 3- pv v D Z O -.'>M-Dm --> mZ- �Z C r 2 �' n Z \ J C') nZ �m JJ DGn gn'avwo•�ua n7 C Z !� DATE W.O. # m T n Q rDm<m9N ro mem WT m zCil `0 G7 Q \N T z zm>>' M2 oM�0 Col. WestbrookExecut Executive Park DoCn�mM mWestbrook, ME 04092N nm m M oNz0 :E~ m Dm 207-774-2843/1-800-539-SIGN m a O T m�z=� OO No m Fax: 774-1193 tnzN 'cci, Z cm m E-Mail: newsign@baileysign.com O DOmm z mF ? @COPYRIGHT � ? N" m < z< m C' 2001 JOHN T. BRENNAN & ASSOCIATES ARCHITECTS 103 STILES ROAR SUITE 202 SALEM, NEW HAMPSHIRE, 03079 PHONE (603) 893-4693 JTBARCffiTEM.COM January 12, 2000 Architectural/Engineering Field Report Construction Review & Progress Report. Re: Interior Retrofit Dymec Office & Manufacturing Facility 25 Commerce Way, Unit #1 North Andover, MA 01845 As requested I am hereby certifying to the following conditions existing at the time of my review of the construction for the above referenced project. Install metal stud partitions 100% complete. 2. Concrete floor plumbing trench filled/compacted and finished. 3. HVAC Ductwork 75% complete. 4. Rough electrical in walls 95% complete. 5. Install metal stud partitions 100% complete. 6. Rough plumbing, 100% complete 7. Exterior concrete walk installation at new entry. Mon December 18 to Thurs December 21 1. Drywall installation 70% complete 2. HVAC Ductwork 90% complete. 3. Electrical installation, ceiling 50% complete 4. HVAC equipment installation 25% complete. 5. Exterior door installation 75% 6. Exterior window installation. 85% complete 7. Sprinkler drops. 25% complete Tues December 26 to Friday December 29 1. Drywall installation 100% complete 2. Drywall taping 75% complete. 3. Electrical rough installation, ceiling 80% complete 4. HVAC equipment installation 75% complete. 5. Exterior door installation. 95% complete 6. Exterior window installation. 100% complete 7. Interior door frames installed. 100% 8. Interior doors installed. 75% 9. Sprinkler drops/heads. 70% complete 10. Fire alarm & exit fixtures installed. 50% complete Tues January 2, 2001 to Friday January 5 1. Drywall finished & primed. 75% 2. Electrical rough installation, ceiling 100% complete 3. HVAC equipment installation 95% complete. 4. Casework installation. 95% complete. 5. Plumbing fixture/installation. 75% complete 6. Ceiling installation 50% complete 7. Interior doors & hardware installed. 90% complete 8. Drywall finished & primed. 75% 9. Ceiling mtd lighting & HVAC diffuser installation 100% complete 10. Interior painting doors, frames and walls 751/o 11. Fire alarm & exit fixtures installed. 95% complete. Mon January 8 to Friday January 12 1. Drywall finished & primed. 100% 2. Ceiling installation 90% complete 3. Plumbing fixture/installation. 90% complete 4. Interior doors & hardware installed. 95% complete 5. Drywall finished & primed. 75% 6. Ceiling mtd lighting & HVAC diffuser installation 100% complete 7. Interior painting doors, frames and walls 95% 8. Fire alarm & exit fixtures installed. 95% complete. 9. Sprinkler drops/heads installed. 90% complete. 10. wall receptacles plates installed. 25% complete Date: January 11, 2001 John T. Brennan & Assoc. "o N2 2748 Date//- ��-e ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... . ......... ............................ ; .......................................... has permission to perform .................. ......... .. ................................. wiring in the building of, at ��. .................... -- * . .............. . North Andover, Mass. Fee�.%�?� Lic. No ..... ...... . .................................................... ELECTRICAL INSPECTOR Check # 33111 - WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (nommonwea19 o f ;Vad:jacliweIli Official Use Only 2,partmeni a`-7i�e Serviced Pcrm1t No. 7T Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] (I[ IVP FlI1nL•\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perf'ornied in accordance with the Massachusetts Electrical Code (MEC), 527 ChIR 12.00 (PLEASE PRINT LV INK OR TY1'E ALL /NFOR,IL-l7'1N) llate: ( I — ( (p -� JCRY'or Town of: K �- R - r\ eWC-r To the Inspector of iVires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street R Number) 2-5- C` �C4Z_ Wc---, ((\ ( t -Owner or Tenant cI rn1-e— (—'I Telephone No. Owner's Address Is this permit in conjunctionwith a building permit? Yes 2 No F]'(Check Appropriate Box) I'w•liose of Building '0.ID , . `tt - ' Utility Authorization No. Existing Service Anips / 1Jolts Overhead ❑ Undgrd ❑ No. of (Meters . New Service _ Anips _ / Volts Overhead ❑ Undord ❑ Nn, ofINterers. Number of Feeders and Ampacity <k49*1- C- %� \e� � vv� FIRE ALARiI•IS Location and Nature of Proposed Electrical Work: No. of Switches No. of Gas Burners No.of Detection andInitiating Devices � Conrnletion of the following table nray be ivniv ..I h, ltrr r; Kb— No. iKb— No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans tNo. °t Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures \ (oO Swimming Pool a bove ❑ In ❑ rnd. rnd. t o. o mergency tg ttmg Batte Units No. of Receptacle Outlets j 2� No. of Oil Burners FIRE ALARiI•IS No. of Zones No. of Switches No. of Gas Burners No.of Detection andInitiating Devices � No. of Ranges No. of Air Cond. Tons 3 No• of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number _Tons KW _ No. of Self -Contained Detection/Alertin2 Devices No. of Dishivashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances K1i; Security Systems: No. of Devices or Equivalent No. of Nater Heaters h�V No. of iNo. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: —� Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover ge is ih force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE cover ❑ OTHER ❑ (Specify) ® t (Expiration Date) (When required by municipal policy.) Estimated Value of Electrical Work: Work to Start: 1 f Z;--00 Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pains and penalties of perjury that the information oil this application is true and complete. FIIblINAME: se--rJx C�.S LIC. NO.:P',S 4� Licensee:�*,1 S�r O -B Signature LIC. NO- � �``9, (If applicable, enter ••evempt - in the license number Imre.) y Bus. Tel. No.A1? �`d-1SSr] Address: 31 fl -e uCZ � vo i�.e.H ?,A,. t^`! MO- Q a11 i Alt. Tel. No.: OWNER'S INSURANCE WAIVER: am aware that the License, 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 ❑ o\vner's agent. Owner/Agent Signature Telephone No. i'i?Rt�fIT I'EE: S 7� JOHN T. BRENNAN & ASSOCIATES ARCHITECTS 103 STILES ROM, SUITE 202 SALEM, NEW HAMPSHIRE, 03079 PHONE (603) 893-4693 JTBARCHrMCTS.COM December 12, 2000 Architectural/Engineering Field Report Construction Review & Progress Report. Re: Interior Retrofit Dymec Office & Manufacturing Facility 25 Commerce Way, Unit #1 North Andover, MA 01845 As requested I am hereby certifying to the following conditions existing at the time of my review of the construction for the above referenced project. Mon November 27 to Friday December 1 1. Cut existing concrete floor slab to accommodate Plumbing. 2. Install sewer ejector pump and related subgrade plumbing. 3. Make connection to existing sewer service. 4. Backfill & compact plumbing trench. 5. Begin Metal stud installation 50% complete. 6. Begin HVAC ductwork installation 10% complete. 1. Install metal stud partitions 85% complete. (Note: 15% of metal partitions not yet complete to allow for concrete pour at plumbing trench.) 2. Install HVAC ductwork. 50% complete. 3. Install wall mounted electrical, & data receptacles. Rough wire 70% complete. Note: Contractor is requesting electrical inspection of 70% complete rough partition installation to allow them to begin applying drywall to metal stud partitions. ate: December 11, 2000 DEG 1 A 20�+ Construction Control PROJECT TITLE: Dymec Manufacturing/Office Interior fit -up PROJECT LOCATION: 25 Commerce Way, North Andover, MA NAME OF BUILDING: Unit #1 NATURE OF PROJECT: Interior Retro Fit of existing 16,000 sf unfinished space. IN ACCORDANCE WITH SECTION 127.0 OF THE MASSACHUSETTS STATE BUILDING CODE, 780 CMR I, John T. Brennan Registration No. 4808 BEING A REGISTERED PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT < > ARCHITECTURAL <X > STRUCTURAL < > MECHANICAL < > ELECTRICAL < > FIRE PROTECTION < > OTHER (specify) < > FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 127.2.2: 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2.2, I SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR I-- I l) UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCA SUBSCRIBED AND SWORN TO BEFORE ME THIS f / (DAY (NOTARY L,7NTHIA L POPSIE, �ry Public COMMWIOn Expires August 26, 2003 TO,,THE/SATISFACTORY MY COMMISSION EXPIRES Gr r j John T. Brennan & Associates ARCHITECTS 50 Northwestern Drive, Suite 110B Salem, New Hampshire 03079-0021 January 19, 2001 Architectural/Engineering Field Report Construction Review & Progress Report. Re: Interior Retrofit Dymec Office & Manufacturing Facility 25 Commerce Way, Unit #1 North Andover, MA 01845 As requested I am hereby certifying to the following conditions existing at the time of my review of the construction for the above referenced project. Site Visit Thursday, January 18, 2001 1. Project is substantially complete and ready for occupancy. 2. All work in the area of construction is complete except for some minor tasks. 3. All required safety functions are in place and operating. Note: The General Contractor, has completed the construction in accordance with the construction documents. inuary 19, 2001 RECEIVED iNli 9 A Z001 BUILDING DEPT. JOHN T. BRENNAN & ASSOCIATES ARCHITECTS 103 STILES ROAD, SUITE 202 SALEM, NEW RAWSMRE, 03079 PHONE (603) 893-4693 JTBARCHMCF&COM January 12, 2000 Architectural/Engineering Field Report Construction Review & Progress Report. Re: Interior Retrofit Dymec Office & Manufacturing Facility 25 Commerce Way, Unit #1 North Andover, MA 01845 As requested I am hereby certifying to the following conditions existing at the time of my review of the construction for the above referenced project. uii 1 ��1- O, 1���� 1. Install metal stud partitions 100% complete. 2. Concrete floor plumbing trench filled/compacted and finished. 3. HVAC Ductwork 75% complete. 4. Rough electrical in walls 95% complete. 5. Install metal stud partitions 100% complete. 6. Rough plumbing, 100% complete 7. Exterior concrete walk installation at new entry. Mon December 18 to Thurs December 21 1. Drywall installation 70% complete 2. HVAC Ductwork 90% complete. 3. Electrical installation, ceiling 50% complete 4. HVAC equipment installation 25% complete. 5. Exterior door installation 75% 6. Exterior window installation. 85% complete 7. Sprinkler drops. 25% complete Tues December 26 to Friday December 29 1. Drywall installation 100% complete 2. Drywall taping 75% complete. 3. Electrical rough installation, ceiling 80% complete 4. HVAC equipment installation 75% complete. 5. Exterior door installation. 95% complete 6. Exterior window installation. 100% complete 7. Interior door frames installed. 100% 8. Interior doors installed. 75% 9. Sprinkler drops/heads. 70% complete 10. Fire alarm & exit fixtures installed. 50% complete Tues January, 2001 to Friday January 5 1. Drywall finished & primed. 75% 2. Electrical rough installation, ceiling 100% complete 3. HVAC equipment installation 95% complete. 4. Casework installation. 95% complete. 5. Plumbing fixture/installation. 75% complete 6. Ceiling installation 50% complete 7. Interior doors & hardware installed. 90% complete 8. Drywall finished & primed. 75% 9. Ceiling mtd lighting & HVAC diffuser installation 100% complete 10. Interior painting doors, frames and walls 75% 11. Fire alarm & exit fixtures installed. 95% complete. Mon January 8 to Friday January 12 1. Drywall finished & primed. 100% 2. Ceiling installation 90% complete 3. Plumbing fixture/installation. 90% complete 4. Interior doors & hardware installed. 95% complete 5. Drywall finished & primed. 75% 6. Ceiling mtd lighting & HVAC diffuser installation 100% complete 7. Interior painting doors, frames and walls 95% 8. Fire alarm & exit fixtures installed. 95% complete. 9. Sprinkler drops/heads installed. 90% complete. 10. wall receptacles plates installed. 25% complete Date: January 11, 2001 JOHN T. BRENNAN & ASSOCIATES ARCHITECTS 103 STILES ROAD, SUITE 202 SALEM, NEW HAMPSHIRE, 03079 PHONE (603) 893-4693 JTBARCHITECPS.COM December 12, 2000 Architectural/Engineering Field Report Construction Review & Progress Report. Re: Interior Retrofit Dymec Office & Manufacturing Facility 25 Commerce Way, Unit #1 North Andover, MA 01845 As requested I am hereby certifying to the following conditions existing at the time of my review of the construction for the above referenced project. Mon November 27 to Friday December 1 1. Cut existing concrete floor slab to accommodate Plumbing. 2. Install sewer ejector pump and related subgrade plumbing. 3. Make connection to existing sewer service. 4. Backfill & compact plumbing trench. 5. Begin Metal stud installation 50% complete. 6. Begin HVAC ductwork installation 10% complete. 1/IM W-111 11MWjff1WW1, 1 W111M 1. Install metal stud partitions 85% complete. (Note: 15% of metal partitions not yet complete to allow for concrete pour at plumbing trench.) 2. Install HVAC ductwork. 50% complete. 3. Install wall mounted electrical, & data receptacles. Rough wire 70% complete. Note: Contractor is requesting electrical inspection of 70% complete rough partition installation to allow them to begin applying drywall to metal stud partitions. december 11, 2000 Location No. ©� Date'L TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ C v SACHUS Foundation Permit Fee $ •; Other Permit Fee $ • TOTAL $ Check # 1 L- -- 16 52 Aly (6 Building Inspector Ec (5 R-5 1 2 3 S'o p W, W1 w1 c G. 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 st,y,fE�T6is Section for Official Use Onl BUILDING PERMIT NUMBER: DATE ISSUED: 3v5� o d`h�i8 �Z. SIGNATURE: // Z G� Building Conunissioner/I or of BuildingsDate SE t5. r ik;�,r ~ 1.1Property Address: 1.2 Assessors Map and Parcel Number: '25 COMAEK� WAy 6ALA.S 1,�� P C �- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr osed Use Lot Area Fronta ge, ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required I Provide Required Provided Required Provided INS 1 1451NG NG 1.7 Water Supply UGL.C.40. § 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal On Site Disposal System ❑ 2.1 Owner of Record RW MWeVt (0MlMY _C�� MlOW4 Si T ' NZTLAND ME Name (Print) Address for Service 1030 Signature Telephone 2.2 Authorized Agent M5 R 5U1LVC-1Z5NG 101 AU9U�OW RD —W7'*J �M- 2 MA Name Print Address for Service: Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ TiMA CS 0 Cv 2215 Address License Number Licensed ConstrIVVO-111,11 Expiration Date Signature Telephone 3.2 Registered Holne Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone ic z 0 J, v D -i M Z O O M Z O Z M 90 O D ic r v m r r P1 L ISM �3 y 1 Lgef $ 1 NC • ,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 o$E RTM Print Name Signature of Own /Agent Date _ 0 1, Item Estimated Cost (Dollars) to be Completed by applicant permit 1. Building (a) Building Permit Fee 8 0100 Multiplier 2 Electrical (b) Estimated Total Cost of ryo U Construction from (6) AA1 vCfl 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 1©0 5 Fire Protection 600 6 Total (1+2+3+4+{{5) -2-0060 Check Number 1'. s�,�u£ J ',..5 �S.FWy. Ni#� '{ A � Iq..-. 'ili .'. t h4! f 14 -wv�YA. D.{�,�{'zi.5 ?�. �35 3 f;Z' , 1. i t to ,(. k S� }� L' e ti -.% �`'.i�'344Kp 4... �1. i :ZTA J. fT'3t ry OM1. '� �N i#f'v4 �1::.-a•4"l i> },ti� ��4�{ �.Iri'S. �i �vJ � ��f �n� .3vJ � `•t jn '� ,',�! � { �Y S a�. . 'Tii" $. W .4A t '� .� �`a. y"i �, i� �. �S j � :G� }� 1` �1::. ti5 Edi t� i3 Z C{�py��,f',X%�i�.j�,.,,':S'tt+�53..V ���`•.v^�Sji f,��v,','�;��J`t�'S;r fh, ��st A��Z`t ��:u4�,,'/?iV r�±ht��, .���7. i�"��.�s.:,..�i?r1S;.s�i�]�3�.���4..fYN,1, 7.':.iJ�,f.��4`��`�}T�sv�h,E��f t, �o�r `,,. �?'<• NO. OF STORIES SIZE " BASEMENT OR SLAB SIZE OF FLOOR TIMBERS OT 2ND 312D SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE h �' _�Jui •sZ:..t � ,1f � r` -'a l -,(k" Sy !` hG Y' 3.n^' t lzy zXal.a y `$, s rY'` 4 JM^ir-' n'.``s""'s ' _0S' i "RIM Ct tkfrry� 3tA.+'Tv'Ye� L Fa' r'i y y i" ): K �i f ^`,c3.t' ;4 , . .$, SECTI DNA.- WV'U . + .. .. 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 ...... No ....... ❑ SECITUN S r PR�1 SSi0 , 11fESIG Z INS R T III ; RViC S Ft 3 D11NGS' 1 ' iTR S S t"t Tt3 COl�tS'i�11iCAN CiItUL PRt�` Tn y89 Cly 116 (+iJi�� C F b - 5.1 Registered Architect: 364f M ITCT"A-1t-1, f 5S6�t�'t�S Name: V� $EfVN�Pf6TOfJ Address " 5 rc�-3331 Signature Telephone Resi�red:)Praiesnu>OM Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of.Respotisibility' Name • ,.�� is Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Not Applicable ❑ �ompago �� T Responsible in Charge of Construction Z i PtVk.all�le3;s' New Construction ❑ Existing Building ❑ Repair(s) ❑ 7AIterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: TWIP5 Qt1t MEN$ AVD QVC WOM 4-A(OkCi RGOW, WET A( PA9TW& V4-' -AVT -tr=KAWT A-1 ❑ A4 ❑ A-2 A-5 Independent Structural Engineering Structural Peer Review Requffed Yes ❑ No SECTION 10a Owner Authorization TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, FAK AMA<fl - M6VI- COM L'&N ( as Owner of the subject property Hereby authorize M9r\ D U l L P�-F5 (NG to act on My behalf, in all matters relative two work authorized by this building permit application BM-0 1l- ZI-o 2 Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 ❑ A-3 ❑ ❑ IA 1B ❑ ❑ 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 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineering Structural Peer Review Requffed Yes ❑ No SECTION 10a Owner Authorization TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, FAK AMA<fl - M6VI- COM L'&N ( as Owner of the subject property Hereby authorize M9r\ D U l L P�-F5 (NG to act on My behalf, in all matters relative two work authorized by this building permit application BM-0 1l- ZI-o 2 Signature of Owner Date FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT r�m6i 0/- A)qd wd J J d�omrq PHONE - ? - /oat LOCATION: Assessor's Map Number '35 PARCEL SUBDIVISION LOT (S) STREET Cexlm8li.e� (..�74-<-, ST. NUMBER 1 ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED _ DATE REJECTED COMMENTS TOWN PLANNER COMME FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS I DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT V IRE DEPARTMENT RECEIVED BY BUILDING I Revised 9\97 im /,;/.z /j -z, R DATE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 51 1 am an employer providing workers' compensation for my employees working on this job. Prism Builders Inc. Company name: Address . 107 Audubon Road -Building #1 Ci Wakefield MA 01880 phone#: (781) 246-1900 G Ohio Casualty Group XWO0352504031 Insurance. Co. Policy # Company name: Address City Phone #: Insurance Co _Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment.as well_as_chni•penaltiesinihefbrmiof_aEIOP WORK ORDER..and_afire_of.($100.00)a dayagainst_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify underJi-I Aif4aVdWsi ]ties of perjury that the information provided above is true and correct. 11/22/02 Print name Roberf Waxman " Phone# (781) 246-1900 Official use only do not write in this area to be complet 'tW town official' City or []Check if immediate response is required Contact Building Dept .p Licensing Board E] Selectman's Office 0 Health Department Ei Other © 107 Audubon Road PR . S31 Building 1 — Suite 19 r D� Wakefield, MA 01880 B�TU�II�Elh7� ENC Wakefield, 781/246-1900 Fax 781/246-0901 �__ . ✓fie T�anvr�za�rcurea� a�✓�ac�ivael�a BOARD OF BUILDING REGULATIONS } License: CONSTRUCTION SUPERVISOR ,A, Number: CS 063131 Birthdate 06/09/1961 Expires: 06/09/2004 Tr. no: 26821 Restricted - 1 -00 -ROBERT L WAXMAN _ 2 LONE O!e'r i N' PEABODY, �MA x01960 . _M Administrator 4 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number '.305 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A.. The debris will be disposed of in: TpS f I E L�p , M A (Location of Facility) 'I C,\Ak Sig ature of Permit Applicant 11--2�-02 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector Location s nomMr-- CE- (AI U&,X-t/ No. &33 Date MORTN TOWN OF NORTH ANDOVER O:.�,+ Certificate of Occupancy $ foo. OC-) '�s''•'°'�<� Building/Frame (Frame Permit Fee $ x-925 00 s�►CMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 10q1q0 4364 Building Inspector C/) m Cl) 0 m _v d • C 0 �. .y n 110 0 CD • n Z y CD Q d O • r as CO) o v `D CD o "C0CD CCD O CCD C O M a v C' Cc CD F v y O 1 Z co o CD 0 CD m co O —• N O Q co FL m .d a -- m 0 o m 0 H CD do CD Z =r -o y _I °: m y -o° T =r m ��d = y O � o O y O •� N O 5m mCO 2 CA Oco O C y COY •O y 0'• It L �� Z VJ < O y tCD om c a3• ccl o �_ yCD c - I i m (�1 _ O CD c� o O CD W o ;(P • z m� ooh. CO) CD C� 03 d O n� CC) 02 rA cn 0 d cn o w "1oa � �z cn :ii z ac m Po oc r O av � M O r O O x omq 0 9 0 c CD 11/21/02 THU 16:47 FAX 2077746020 RAM ASSET ,MANAGEMENT a�001 • , ` O ! I I I I f I I 4G 4PP l N 7777, C C 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 20"N'TRINIM171,'This Section for Official Use Only_ � � - � ' BUILDING PERNIIT NUMBER: DATE ISSUED: SIGNATURE: Buildin& Commissions or of Buildings Date -'s,11 Property Address:aMftgg-�— 1.2 Assessors Map and Parcel Number: U 4-44)Pe< IY)A,S�.r ce 7- e Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: --r, 2,— — ZoningDistrict Proposed Use — Lot Area (sf) Frontage (ft) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide lkaired— Provided RecItlind Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 private 0 zone — Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner of Record Name (Print) Address for Service: S' atu Telephone 2 2 A uKonzed Agent V Name Print Address for Service: K-Q-2- Sigriature Telephone 011, 0- W, NEMIROW WIN" 7,il, R"RIWAI � " W 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number 17 - v C Construct* %icensed Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable P" Company Name '. Registration Number Address Expiration Date Signature Telephone 00 —7;4en en /9l" T A % - I, 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 / Trl o i►► 4—x `T /cu �rG t i d �► T Print Name v toe,, Signature of Owner/Agen Date 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 ta) X (b) a 8/o tJO 4 Mechanical (HVAC) �d /Y 5 Fire Protection c� d vo Ot TS c,` ` 3 002 , 0'0 6 Total (1+2+3+4+5)�Q y Check Number t 4 "'V �{ �Y, C.:. � ,.} NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1; �'F,�'1`. i"'.a'.,r 3l✓h }"'ai->Y ��oh'd.,�Y 5" 3h "'L 3y.^% 3' 2 .. ';,�,+'%i �.`Yi 'rwh,7H+� ^� � iN1kiYR�."iYe• -C' -, '' t r'�, / 4 '�� ��A_..-�.C;..�;r ��r: �+aGY. �Y.d?'T�'!;� ✓� n4h`Rs�s �A- � y'�< s� '!•.�'y. �,rt�.F�`ih},T.F ..`tel -n tt�o. +�-. $[ 5. :<'� 12 ON 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 ....... No ....... ❑ sECTIox S ,;PROF aN. FS"C x 1€7ailLJC t +t ) R'Jr s v .'MT BU1C D r AND COxS`1FRi3�"�Iax co3� RO iI'T 1 T.6 c R l i ; C+Eixi� l aRlr� T1EiA1 D`3�, GF bF'Ei C D= 'A 5.1 Register/ed Architect: s Name: a Address M Signature elephone 5 2 R li Prdesstti�a� � Are of Respo sibility Name: RegistrNatigirNumber Address: Expiration Date Signature Total Not applicable (.— Name: Registration Number Expiration Date « Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Name Registration Number Expiration Date Address Signature Telephone F Not Applicable ❑ Company Name: Responsible in Charge of Construction ON New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ��liG2�o�C ? ti/� , �,QiuX ��4dG .S� FTS //l•9G�Tt% /C. 6 �Ni G� ,SiO/J GC ,, /in L ^4 4I,- ❑ A-3 ❑ 0 IA 1 B ❑ Independent Structural Engineenng Structural Peer Review Required Yes ❑ No P" SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 6?-IM4 (J1 p _ APJr=s co , as Owner of the subject property lh v1A-e "V-' -� y Hereby authorize Ile, 4-ly if G 77" °t' �" 1°�� y .?� to act on My behalf, in all matters relative two work authorized by this building permit application Of er Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 0 A-2 A-5 ❑ A-3 ❑ 0 IA 1 B ❑ B Business yam 2A 2B 2C ❑ 0 ❑ C Educational 0 F Factory 0 F-1 0 F-2 ❑ H High Hazard ❑ 3A 3B 0 0 I Institutional ❑, I-1 ❑ I-2 ❑ I-3 0 M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B 0 0 S Storage 0 , S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use 0 ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE 4 Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: Independent Structural Engineenng Structural Peer Review Required Yes ❑ No P" SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 6?-IM4 (J1 p _ APJr=s co , as Owner of the subject property lh v1A-e "V-' -� y Hereby authorize Ile, 4-ly if G 77" °t' �" 1°�� y .?� to act on My behalf, in all matters relative two work authorized by this building permit application Of er Date rA W cz /E, Z. 0 �v cc tt ` .IvEc g:c m �: = O F Eac�Y .4 C/) CEO GN y.�. E=j=� z ; Ci W E ^`y v a 5e `' Qi 42.�4/� O �N y c/J m 3 = y m H =Cc' :m IL19 lr ^, a : .2"20 'D z N C C O O E� o CLU o c/).p: a .: m Q H D CO N O C ,e C Z �F O O •� C! V O CO C Q m C •O = o:0=3 N a o ym0 c cn ev t mLu w �. c.* O.= O C Z 0 .0 OLLJ •N O U m 0-00.s-0 m cn C HQ CF.40 a m'O o- J F- m L- = 0 cL r m O O O CD L _ O O C z a �. O y � O I I co cm CD O O .co)E m m CD 0 CD CL _I, C13 O� G3 L e.2 o a CL �Q O rt'r C O O V J 'p CL. C3 O c z Co v COD d° c C C CL _ C V2 ' _ c' 0 U) ccw w ccw VJ b w v .� a U) 04 o w A a o w o w v r. E c u q x w :j o C2 ccw q x a O u a w o w � cn q w a d .� o oG ro q w z A w w � W z cn Q v cn Z. 0 �v cc tt ` .IvEc g:c m �: = O F Eac�Y .4 C/) CEO GN y.�. E=j=� z ; Ci W E ^`y v a 5e `' Qi 42.�4/� O �N y c/J m 3 = y m H =Cc' :m IL19 lr ^, a : .2"20 'D z N C C O O E� o CLU o c/).p: a .: m Q H D CO N O C ,e C Z �F O O •� C! V O CO C Q m C •O = o:0=3 N a o ym0 c cn ev t mLu w �. c.* O.= O C Z 0 .0 OLLJ •N O U m 0-00.s-0 m cn C HQ CF.40 a m'O o- J F- m L- = 0 cL r m O O O CD L _ O O C z a �. O y � O I I co cm CD O O .co)E m m CD 0 CD CL _I, C13 O� G3 L e.2 o a CL �Q O rt'r C O O V J 'p CL. C3 O c z Co v COD d° c C C CL _ C V2 ' _ c' 0 U) ccw w ccw VJ ;;o O ^G rA rA ..� w04 x o as u� \ w2 U cn OU a o 'b w° .r. a�' U ib w a o : V; c� a �' .i on in w a 0 W � w p,, W Xi nD „ U cn w U z c� X D° id w W a w 6J G rA z aJ �' cn v Q v O U) C r 2: mCF -� o CD 0 CL �s=j=ig CD C SM m d 05 m 3 t yC C In O m A ID '0 C m O O. TiV � m Or. Time m ; kms m Z o` o c a 2 0o mw� N :d COD WC 4 5 'O Z c •- F. •N d Z C! c Z 'E v `r ® N o L m QCD N) a m- O: _ R CD h �O a.: m .7 R, 4 Q.D E L O z a Q O y o =E o, C CA a� y m m CD O = C ~ }+ CD co � L CCc O a CL C Q ca 0 .0" C COcc v J .0 CL 0 O CA Z 0 V ca O C • C y D ci D O cd x� E� x A b . °o w •� cn 0O w z z A W ro G w m w � U � w w Z a on n°' � w W W W ono aG " cn _ w a 0 W a z ono w E" w w w °' rA z cn Q . i cn .�5 0 Na 2 ::. O V@mcv am .Iv' boy z CCL� v WK m C Cf) • _ :D p 0 06 O As z s O CMP I -- CD U) C,* m �p r Q� m .3 y r) a �A 'Q z y C c O O E CD y �d O CLU r(r��� •O �' y m �J 2. hoc m '� V H O O 1 �Z CD CL 0c Q y (D C 'p = O dO- 0 N ~ *O' y m r0" ~ C CO C 4;:s W O � * C .� U. M C .Z c Z � m .y C.3 .ui m p 0.2 C V_i a' m= O� _ m H t q0,. d •_.. Cn � co O 0 X� L v o � � Z co = O ca C C IO Qf C o� y a� a 'E m m CJO co C d O � C Z w v CO) d° � C C h ' 0 vf� 0 CO CI) frW W frw CO 015 d.ow4A-1 U w'T- tt' plz /f al t � f eOEM- Owe 'se Go 1. e-000- (. F'o.Zk. rl FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. 'APPLICANT cr1o�r. PHONE �6�J 6�_ 5Fao3 /ASSESSORS MAP NUMBER LOTNUMBER ooiy SUBDIVISION LOT NUMBER ,STREET eoln en c ieec, 4,.9 V STREET NUMBER �S OFFICIAL USE ONLY RECObRvffiNDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER CONQAENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR - HEALTH DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS, a� PUBLIC WORKS - SEWER / WATER CONNECTIONS /Ei- 44 & It —Af -00 VA ✓' CONPAENTS Ali 1GD DATE DATE REJECTED �" I/-14,�"; b RECEIVED BY BUILDING INSPECTOR DATE 0142P IBUiLUIW, DEFiA; MEW �. vviuiiivivr.wuvi ru�.�uwuJclW Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. O1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: �y ��✓7�yG7ioy �.��Y :Z�r C Address %SD C� sr-�nc%./J %fi/.N C /��2 /r✓ ,�//v � Ci /%�'9 G �i Cs �G I7/ /� Phone* C6 03� 6d7- ydo3 Insurance Co. %C/9 Oi /9 --7'/7S 1-9 -7 zC Policy.* Bo 0 075�4 Company name- Address City Phone # Insurance Co Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties ory that the information provided above is true and correct Date //- -y o 0 Print name A -r T '�� /dies'���T Phone# Official use only do not write in this area to be completed by city or town official' []Check if immediate response is required Building Dept Contact person:_ Phone FORM WORKMAN'S COMPENSATION (] Building Dept C] Licensing Board E] Selectman's Office F, Health Department 0 Other A4F4011100CERTIFICATE F LIABILIT IN DATE (MM/DD/YY) ,1,06/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION > The Rowley Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 511 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALIEB-IHE G0VFRAGF AFFORDED BY THE POLIr ES BPI OW Concord NH 03302.0511 INSURERS AFFORDING COVERAGE INSURED INSURER A: Acadia Insurance Company Kelly Construction Co Inc INSURER B: 750 East Industrial Park Dr. INSURER C: Manchester NH 03109 INSURER D: $ INSURER E: OVERAGES 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 _POIES.-AGGREGATE-UMITS-SHOWN Y-HAVE-BEEN-REDUCED_BY-P-AICLCLAI NSRf TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (mmtpnm�CPA002545914 A GENERAL LIABILITY 07/01/00 07/01/01 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY _ FIRE DAMAGE (Any one fire_) $ 250,000 CLAIMS MADE 1XI OCCUR MED EXP (Any one person) $ 5,000 — PERSONAL 8 ADV INJURY g 1,000,000. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JET LOC A AUTOMOBILE LIABILITY X CAA002546014 07/01/00 07/01/01 CO SINGLE LIMIT $ 1,000,000 ANY AUTO accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS X BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC ANY AUTO $ - AUTO ONLY: AGG $ A EXCESS LIABILITY x CUA002546114 07/01/00 07/01/01 EACH OCCURE_ RENCAGGREGATE $ 1,000,000 OCCUR CLAIMS MADE $ i 000,000 DEDUCTIBLE -- RETENTION $ $ - — -- WORKERS COMPENSATION AND OT A EMPLOYERS' LIABILITY WPB002545814 07/01/00 07/01/01 IWC O YSSTATU-IMITS_ - --- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE_ $ 500,000 E.L. DISEASE - POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONSA.00ATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project: Dymec, Inc., N. Andover, MA. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Ram Management Co., Inc. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Mr. Eric Mora NOT E TO E CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 121 Middle St. I OSE OB Portland ME 04101 LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25-S (7/97) Arnan rnRanRA nnm ioan 141 { BOARD OF BUILDING REGULATIONS I �Llcense: CONSTRUCTION SUPERVISOR Number: CS 040484 Birthdate: 12/17/1939 i Expires: 12/17/2002 Tr. no: 4960 - Restricted To: 00 a JOHN R STPIERRE �—/�►' 7 " I171 STARK HGWY N DUNBARTON, NH 03045 Administrator �I - Nov 16 00 02:43p Steve Marco Attention: Mr. Thomas J. Roy Company: Kelly Construction Fax Number: 1-603-627-3460 Voice Number: 1-603-627-4203 From: Steve Marco Company: Dymec Inc. Fax Number: 978-250-4782 Voice Number: 978-250-4782 Subject: Letter for chemical use and discharge Comments: Hard copy will be in the mail this PM. 978-250-4782 p.1 Date: 11/16/00 Number of Pages: 1 Nov 16 00 02:43p Steve Marco 978-250-4782 p•2 Fiber Optic Solutions for Industry November 16, 2000 Mr. Thomas J. Roy, Prudent Kelly Construction Co., Inc. 750 East Industrial Park Drive Manchester, NH 03109 Re: Usage and materials storage at 25 Commerce Way, North Andover Dear Tom; Dymec Inc. designs and manufactures fiber optic communication transceivers used in the industrial applications. We are categorized as a very light electronics manufacturer utilizing printed circuit boards, Purchased from others, stuffed with electronic components, soldered and then cleaned before assembly and test. We will store less than 50 gallons and utilize less than 10 gallons per mouth of solvent based materials that are used for sealing our electronics and in our ultrasonic cleaners for washing flux from boards after wave and hand soldering operations. The chemicals used for clearing are not discharged through the sanitary limes. They are all reclaimed, documented and disposed through licensed hazardous waste companies. The other solvents used will be very small amounts of acetone and alcohol used for spot cleaning with cotton swabs. The dishwasher and sinks will only be used for clearing tools and plastic dry storage bins and will discharge dirty soap detergents, of the household variety. The tools and storage bins must be washed regularly because they are antistatic and loose their antistatic characteristics if they get dusty or dirty. All flammabies and toxic materials will be stored in appropriate cabinets and containers in accordance with OSHA and proper manufacturing processes. If you need any further clarifications, please don't hesitate to call. VIM•► Steven M. Apostolides President/CEO Cc. File, Eric Mora DYMEC Incorporated • 27 Katrina Road • Chelmsford, MA 01824 Tel: (978) 256-0025 • Fax: (978) 256-1510 FACSIMILE Ram Management Co., Inc. 121 Middle Street, Portland, ME 04101 Tel (207) 774-1030 Fax (207) 774-6020 Date: November 15, 2000 To: Tom Roy Company: Kelly Construction Co., Inc. Fax # 603-627-3460 From: Mary Ann Ryan Keller (Eric Mora's Assistant) # Pages: 2 Re: Window Detail Drawing for Dymec Space No. Andover Commerce Center FIECEIVED NOV 1 G 200a K�uy CONSTRUCTION CO., INC. I am faxing you a reduced version of the above referenced drawing for your immediate review and will be mailing the original full scale drawing (via Airborne Express) for your receipt tomorrow. THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THIS MESSAGE IS NOT THE INTENDED RECIPIENT, OR IF YOU ARE THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA THE U.S. POSTAL SERVICE. THANK YOU. � f-1 5-w Q C . s . o�-'C (ro�� V o �. 5�'tJ �Y! � LZs � z Amo M e r ZZq N myF c =,,n € n� �1 (�7 Q,�yy, _ Y 7d F -nr r1iY111111 ? Q F Z mato i C za' C�yyC O Z vmm� A Q Q (27 I I NC / YIIJJ yl roll 99 ii 1 iQ • � G N � r I I V-1 1/4" FIELD CUT OPENING HEIGHT / 9 q 1 z • n Q r• ,^, xZ O v N • ,�y�J n m ' Zm II • 0 r 3 A C1 • - m o Oz 9 • • i n /_ S I • k i �$ A O .. T-,. ll,-: COJ A V) C o IAO 0. z G � � •4u �� V♦ V u !+- G z o r 9 OIX � v 0 z * O�_g$� 1�ZiR^s�a z (7 UU DI �f �� 21 r"F z�€ CO N av na a 211 LA M Z o� a� Ir_n O s I . i F o r M R .� P l n DZ z z ( F.>n,.z*z A 1 o r o � m a m -H l7 N 2 m X Z Z O J T �I V D C O z A :E rn r r Z 00 m z D ;u O g Fri p`2 r Fri Ft A r- o O Z D O r —I � W In O D z Z �c m X r- r— J sz O Mz M 0 c c� t-+ O Z , v L o `tr6 �Oi G � C7 _ L 1 o r o � m a m -H Z Z O J O rn m z g Fri r Fri Ft r —I In O Z N X J a: 0 I 4 r O O A MAP Town of o ke (( �`'''""`' NORTH ANDOVER PARCEL 13Z�iLDt7L BUILDING PERMIT INSPECTION REPORT PERMIT NO UNIT NO.: PROJECT: Te-N?lt -C E' l" `'t ' INSPECTION DATE: FLOOR �mtR01 dt"ll r43404' WING BUILDING NO.: REMARKS: Et -M, 0512kl i O' P I1 rs Cr L.,. s r -An,, o oma-• �z o CYa X7-cI t.. PA, -,k 'tt*iet:, , I -'r &j Cade, ec- S ZL-Y L°or►1 iene"10Cc W`®p� �� MAP ,00 eA-CA .; TownGL, PARCEL NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.. PROJECT: F+'i-{-tri ,LC-�sE' Q",l "'� INSPECTION DATE: UNIT NO,: FLOOR: WING: BUILDING NO.: REMARKS: i �tc2 S"F,�4 S V^��or,c�1� Gf: > L f �ti D o U'fl /Y1 d G%G" 03- �.►�►.r-�Yt_S £�(�»-nr�zis-� r= � �- - 1�.�� (�2ot�C�-wc-S _o (:Z-. ? 1 -07� MAP ND D rz.e5 VZa ., .... Town of 'c• �'` NORTH ANDOVER PARCEL : Otzmem BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: eA^ `�• 'LLP' INSPECTION DATE:/. 08 uU UNIT NO.: FLOOR.=L���r'�'dY�IVG: REMARKS: 44.L- 4: L A-3li c n 0 BUILDING NO.: Map 035 — Parcel 0014 CERTIFICATE OF USE & OCCUPANCY Building Permit Number 250 Date Dec 18, 2001 THIS CERTIFIES THAT THE BUILDING LOCATED ON 25 Commerce Way — Texxon MAY BE OCCUPIED AS Office /Light Manufacturing IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Ram Management Co, Inc ADDRESS 121 Middle Street Portland W 04101 Building Inspector Cl) m m m m m 7) Cf) m CO 0 m Flo I CAo So -0,1 Cf) m z Tr co to co 40. M § CD C 0-4 z 9 Irb � 4 = Z7 Cl) O \moi CD O co CD CD, .CL C, va • CD CO2. m CD CD M CD ca C-3 CD cto 0 CD CL cr =r CD CD 0 CD 7� c=2 t" cm a CD vi, co ca A CD Flo I CAo So -0,1 Cf) m z Tr CD to �_ 40. M § CD C 0-4 z 9 Irb � 4 = = 8. 0 44 CD -4 \moi CD Z CD ca O -n CD Flo I U) U) 54 F 0 pi . C0 So -0,1 Cf) m M d O Tr in < to rD r 40. M § CD C 0-4 z 9 Irb � 4 = = 8. 0 44 CD -4 \moi Z CD ca -n =r CL 0 m CD CD M CD ca CO2 o CD CD C,3 7� c=2 c3 co) .2 A O H o CD =r ='O ca rri co h to gm CD CD cC2 c 0 CD 9 g to w< �' ty CA GO cr CO3 CD =r C43 sil to 'o c): CD CD CD Z cl CD CD Po Ap C-) C3 C* CD U) U) 54 F 0 pi . C0 -0,1 Cf) m M d O Tr .7 CL 0 rD r 40. M `''F� ; Nom, 2 0-4 z 9 Irb � E :. - �I T V V r \ \moi 0, UP 0 O� ,kORTN nsf" r6 NO Zoning Bylaw Denial _Item Site Plat, RaViEfw SPiiPermit Town. Of North Andover Building Department Sa`"US�� 27 Charles St. North Andover, MA: 01845 Frontage Exception Lot Special Permit Phone 978-688-9545 Fax 978-688-9542 ..Street:.: Height Variance Map/Lot. Variance for Sign Request: Date: Please be advised t at after review of your Application and Plans that your Application is DENIED for_the followii q Zoning:Bylaw4re4sons:. -0,emecly for the above is checked below Item # Special Permits Planning Board # Variance _Item Site Plat, RaViEfw SPiiPermit Setback Varianc__e — - Access other than Fronta e S ecial Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Per Lar a Estate Condos ecial ioemit 4 Special. Permit, Non -Conforming Use ZBA Planned Develo rnent District Special Permit Earth Removal S ecial Permit ZBA Special Permit Use not Listed but Similar Planned Residential"S ecial.Permit T- S ecial Permit for Si n R-6 DensitySpecial Permit Watershed Special'.Perit m Special Permit reexisin nonconformin The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the, applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall<!be: grounds for this review to be volded.at the discretion of the Building Department. The -attached -document-titled"Plan Review Narrative" shall be attached he and incorporated _herein by reference. The building.department-will retain tIVOlans. and documentation for -the above `file. You must file a new building. permit application form and begin the permitting,process. AepBuildin De amrtent Official Signature Application Received Aplication Denied Denial Sent:�2C _ If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further plain the reasons fordenial for the application/. permit for the property indicated on the reverse side; .iY' `��t��ij. fiFR'S�b 1�0 ,15� aaL1 �1" � S�thOb �o •� �' '�� y0\'�'.f�±�1'�7Cii�� s� � {.� v/C^/ S QQ ''ll cc V 1 .In 1 ` A M 1 u�-- Y04A A 1 { wd Lam. 3 �o 7N vc7►-quo Referred To: Fire Police ealth Conservation in Board Plannin a `artment.of Public Works Other istorical Commission BUILDI.N.G-DEPT. PERMIT NO. 1 APPLICATION FOR PERMIT TO BUILD—NORTH ANDOVER, MASS. PAGE 1 MAP NO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ZONEI SUB DIV. LOT NO. LOCATION 8 G;.Fie-h ST PURPOSE OF BUILDING gQ�fl L`FA�r�� o„ yoeQS� /Ay I'�yWN r %ra cue OWNER'S NAME 1R_pyp�.Y �fF11� ,C®� NO. OF STORIES SIZE 93 r�� Z�D�`� OWNER'S ADDRESS / — BASEMENT OR SLAB ARCHITECT'S NAME rrL � SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME j{�`M 5&-,,wr 8_0/Jl�/ 4LA)ZIM,r -Ga/IIJ C_� SPAN N DISTANCE TO NEARESTBUILDING1 DIMENSIONS OF SILLS DISTANCE FROM STREET "J E] 3 POSTS VI`-+VY/T E gyp; , 1 DISTANCE FROM LOT LINES - SIDES 6 REAR 115= "' GIRDERS AREA OF LOT 20. 56 AC �/ S FRONTAGEFCd7 !� IGi 7 HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW No SIZE OF FOOTING X IS BUILDING ADDITION yowl MATERIAL OF CHIMNEY IS BUILDING ALTERATION /"0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER Ye3e BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER No IS BUILDING CONNECTED TO NATURAL GAS LINE k16 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR F E E ,/'1 •GF6 PERMIT GRANTED g //•s 19 3 PROPERTY INFORMATION ' LAND COST EST. BLDG. COS EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM .y SEPTIC PERMIT NO. A107 - 4 O`4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR T! WYMO 'NV1d lO1d S30V1d3H SIHI 'a3SOdW1233dns '013 'S30VH ` - E) 'S3H:)UOd HlIM 'SONIa11f18 d0 SNOISN3WIa 10t/X3 aNV S3N11 101 WONA 30N`d1Sla aNV 101 JOSNO1SN3WIa 10t/X3 MOHS.LsnW N01103S SIHI S Z l I ADNIvd (1000 L Ga0:)311 JNiciina 0NIIV3H ON _ I P'£ I 1 l PC 1.W•9 JINIJ319 110 SWOOa d0 'ON L SVJ Sd31V3H 11Nf1 21:1-1 1NVI0Vd JNINOI110NOJ NIV NOdVA NO d.1.M IOH _ SN31dVd DOOM 'S10J R '$W9 1331S WV31S !NsnA SIV IOH 03JNOd 3JVNsnJ SS313d1d _ S10J R 'SW8 a39W11 1sI0f 400M 0NIIV3H ll II 9NIWVad 9 :1lYc1l� OaVa 3111 x0013 3111 S3af11X13 Nd300W ON13004 11021 _ N3MOHS 11V1S 13AVdO R NVI JN19Wflld ON 31VIS FINIS N3HJ11A S39NIHS DOOM kdOIVAVI S310NIHS 1lVHdSV 19SOIJ N31VM ('X13 t) 'Wil 131101 03HS OdVSNVW 1Vld 13d9WV0 X13 C) H1V9 dIH 319V0 'JNI9Wf11d Ol d00a 5 �I NOOd 3NOIN3dos ONI81M 3WVNd NO 3NO1S AZINOSVW NO 3NO1S )119 dRINIJ d0 'JNOJ NOOId R 'sdiS JI11V 3WVNd NO XJIN9 ANNOSVW NO XJId9 —� _� £ Z _ I _ 9 3111 'HdSV 3WVdJ NO OJJf11S ANNOSVW NO OJJf11S JNIGIS '1d3A NOWWOJ — `JNI011 SO1S39SV `JNIaIS 11VHdSV S310NIHS DOOM G•P!\ONVH H1dV3 313dJNOJ JNIGIS dOda SONVOUV15 Sa001d 6 II S11VM 4 N3HJ11X N83GOW S3JV1d 3dld V3dV JI11V 'NIA V3dV .1.W.9 'NH WOOd GV3H 1.W.9 ON '/c 'A 'A llfld V3dV 1N3W3SV9 E £ L l 9 N13Nn IIVM ANG N313V1d SN31d G.MGdVH 3NO1S NO XJIM 3NId '>I.19 3138JNOJ 313dJNOJ HSINId 7JOla3INI 9 NOuvaNnOd Z NOIlonHISN00 I ii 4pI 30 S1N3W1NVdV AIIWVj 'wnw S31d0!S AIIWVJ 31ONIS Z l I ADNIvd (1000 L Ga0:)311 JNiciina Date......................../...... 1% VtORTR 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that..A..'�F. ......... ................................. .................. ,---b-as permission to perform.41-4,—.1-I.Sia .. ...... .. ................................... wiring in the building of ................................. at............... ....................................... ......... North Andover, Mass. Fee/dIS ... . ...... Lie. NA�.ra ..... �6. A ELECTRICAL INSPECTOR Check # 04164(o .990 #", Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Check i, 0 ev. 11/991 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: 12/28/04 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number 25 Commerce Way Owner or Tenant Plastics, Inc. Telephone No 978-681-8414 Owner's Address Is this permit in conjunction with a building permit? Yes © No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead Undgrd ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Fluorescent fixture retrofit Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans TransTotal Trsformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No, of Lighting Fixtures Above ® In- ❑ Swimming Pool g rnd. rnd. o. o Units Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Tota No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: IKW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E) Municipal Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water XW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage BathtubsNo. of Motors Total HP elecommunications Wiring: No. of Devices or E uivalent OTHER: F LE "c . -� — i o r7 .e - [Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER El (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: A.R.S. Electric, Inc LIC. NO.: A16526 Licensee: Anthony R. Staffiere Jr. Signature / LIC. NO.: E25233 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 781-397-7895 Address: 88 Mt. Vernon Street Malden, MA 02148 Alt. Tel. No.- 617-257-2889 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 F] owner's agent. Owner/Agent Signature Telenhone No. PERMIT FEE. $125.00 'n 0 MA,. JD Ci r`t' CY f1 V,; AJ, JAj TO d 1, f f V L �t U eF ai iT41il ni t i,r-' I T I g -1j. Ji.jo -n-911) 4 I.Ji. (cm;'i j -,h J, j,1 tu I v r ul J. 9 %t e,1 r fit x", 0 it %M'