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Miscellaneous - 305 ABBOTT STREET 4/30/2018 (2)
Bios AbO 1 i i BUILDING FILE i Date.......�...".�..�: �..... ' NORTH °� •,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �$$4cMus�t This certifies that ................� ...Y.��......T...... f lL?.................................... has permission to perform ......ScUP..T .....Sp.......................... wiring in the building of............�4/Z�ac� ........................................................................................... at ........... 115- .460 ' l-.S�'-`................ .,North Andover,Mass. .. ............ / Feea...Lic.No. . y/.. ....... .. .. .... -t-9 ...... i' E ECTRICAL INSPECTOR Check# n n C.amnwnweaLLh o � Official Use Only � 2 Permit No. 47,ZG� -Fal&..t o/-tcc77 ire Ssrrricee Occupancy and Fee Checked r` BOARD OF FIRE PREVENTION REGULATIONS v.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ) 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: Al, 9NI)0�12W 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) _j -V- _ �Q/Ir-1--y/ Owner or Tenant (MokwAl Telephone No.&11//7 Owner's Address 9 L2Z/ ), Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Bog) 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: Completion of the fffiblZowingtable maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- a o mergency Lighting No.of Luminaires Swimming Pool nd. grnd. 0 Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices No.of Waste Disposers eat Pump 1. 1 Tons KW .of Self-Contained Totals:I Detection/Alertiniz Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal 11 Other Connection No.of Dryers Heating Appliances KW Security ystems:* No.of Devices or E uivalent 7 No.of Water I No.o o.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Viecocal Work:�1✓: (When required by municipal policy.) Work to Start: 3 % /2 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 cover is in ford,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ff BOND ❑ OTHER ❑ (Specify:) I ceMfy,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: LIC.NO.: 3-3 C Licensee:zpzl/,l//�1jJ� j� �/ �l/1U Signature LIC.No.:_Jxq (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.-97e7' Address: /0(/ 67-7011 Alt.Tel.No: *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. .33 a 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)El owner owner's agent, Owner/Agent PERMIT FEE. $ Signature Telephone No. i 7*e Commonwealth qfManachasetft Department of Indwtrhd Accidents Office of Inions 600 Washboon.Street Roston,M4 02111 www massgovldia Workers' Compensation Insurance Affidavit: Builders/Contrae ori/Electricians/Plumbers Applicant information Please Print Legft First Alarm Name(ausiness/organizatiomridiviauai): 100 Trade Center Suite G-700 o urn,MA 01 UU1 Address: 1-800-339-6468 City/State/Zip: Phone#: A,r_e,yoe employer?Check the appropriate box: Type of project(required): 1.L&O am a employer with �_ 4. ❑ 1 am a general contractor and I employees(full and/or part-time). have hired the sub-contractorsS ❑ w construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. modeling ship and have no employees These sub-contractors have g, Demolition workingfor me in an capacity. employees and have workers' Y pa rtY� $ 9. 0 Building addition [No workers'comp.insurance comp.insurance, required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.C3 1 am a homeowner doing all work officers have exercise/their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12- Roof repairs insurance required.]t C. 152,§1(4),and we have no 0 employees.[No workers' comp,insurance required.) Q 'Any applicant that checks box#1 must am fin out the section below showing their woitm'compensation policy Wit. t Homeowners who submit this aflid"indicating they are doing all work and then hire outside contractors mum submit a new affidavit indicating sit& tContractors that check this box num attacked an additional street showing the(tame of thestd-amtrncturs and soft U60dicr or not dura emisies trove =loyees. if the sub-contractors here employees,they must provide tbe work W comp.policy number. x ss�o—o oxo I am an employer that is providing workers'compensation insurance for my employees, Below is ike policy and Job sue Information. Insurance Company Name: i �� � Policy#or Self-ins.Lic.#: ���1 �0�% Expiration Date: Job Site Address-3j �A5&7T Gi1y1State&ip: N, ANIX,11�' /2�0,W Attach a copy of the workers'compensation policy declaration page(showing the policy==her and expiration date). Failure to secure coverage as requited 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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eerti th ins n ©f perJnry that the inJormadon provided alae is true and correct. Si Date3a Shone# ;?Zy-3 3 2 OfJ7ciat use only. Do not wr#e 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/To"Clerk 4L Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M. t)M ONW TH f A HUSM, ax, s h: ISSUES THL FOLLOWING".=Li' "' k �3� RED .5 'T CONTRACTIA F20'NALD FAI L rA ULO 301 NEWRIR ..ST M a �. i SU 1 .Ir X43 d IEtS �, t , i01a�3""1 } OF M Mks z Ate: I5SU.ES TKE FOLLOWINrr�'L'I'&SE h4: ,'` ` A` 51RED SY6; !1 TECHNICIAtf''' � i t pwtD L PALL I AkOLO �3011YNEfw,•t1�fY ST YlE�Y F 4 0193"1�. .. t� 4 1 F;:, 0 / rl ° 5s 64844 jIMUGMUMUR :)0partment or pubis;safety :.cense: SSCO-000332 RONALD L PAOUAROW 3 , 100 Trade Cancer Ste"1�` Woburn MA 01801 ;. i orn:rzas�see?er 06/11/2015 Date..::.......-./ �. NORTN "`" '•otic TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING BgACHUS� This certifies that ...... '\. ....� ............................ ...................................................... has permission to perform .........N-w 14ovS r- /../............... ................................................................ wiring in the building of................... ` ..................................................................................... at-3C6— ��� ... ...... ...ST............ ........ ...........North Andover,-Mass. Fee-57.. ...Lie.No. " 3/.. ........................: .....................:.. .. .... .................. ELECTRICAL INSPE�OR Check# 5 2234. Commonwealth of Massachusetts OfffcialUse Only Department of Fire Services Permit No. 1 V2= 3,11 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: &)I Y 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) 4 �A o)A �-- F— 36-5 Owner or Tenant ['QgK A4J Telephone No. I 9k )-,5 Owner's Address Is this permit in conjunction wigi a building permit? Yes No El (Check Appropriate Box)Purpose Purpose of Building ' Utility Authorization No.? t j-,7z t4 e) 15-1 - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service G� - Amps /ZO 1Z VUVolts Overhead❑ Undgrd �No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fv v j. leA, Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd. grnd. R2Lterj Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of DeteInitiating an Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: *"'* ' " ****'**.......................' "*** Detection/Alerting Devices No.of Dishwashers S ace/Area Heatin KW Local❑ Municipal [I Other Space/Area g Connection No.of Dryers Heating Appliances KW SecuritNo.o Systems:* or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent WirinNo.Hydromassage Bathtubs No.of Motors Total HP Tel ns No.of Devices oEquivalent E valent OTHER: Attach additional detail if destred,or as required by the Inspector of Wtres. 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 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)4 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperj�u ,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: /-7L/9 Licensee: Signature LTC.NO.: (Ifapplicable,enter" empt" hl� nse nuer line.) s.Tel.No.: 7 -202Address: Q 11t.Tel.No.: lob —/day *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S" icense: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE.$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shallbelimited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. 0.Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass IN. Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: !G /Uag --9 Cc L" i Inspectors Signature: Date: ARTIAL ROUGH INSPECTION: Pass F?] Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Com s: 14 41 Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed❑ Re-Inspection Required($.)❑ Inspectors Comments: F/4V 4D Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Department of IndustrialAccidiihts Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation]insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Ledbly Name(Business/Organization/fndividual): ( Q / ���G Cly� dot! Address: &0 ` /;,Ik S'v City/State/Zip: eyJ,�4_U&�� Phone#: (9 : Are you an employer?Check the appropriate box: Type of project(required): 1.W'I am a employer with— 7 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers' comp.insurance. y. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 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 12.0Roofrepairs insurance required.]t employees.[No workers' 13.0 Other comp.insurance required.] *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 ai'e doing all work and then hire outside contractors must submit a new affidavit indicating such. }Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert uri he pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: i Information and Instrncta®ns 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 fs 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 issuanee 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)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 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 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 whichwill 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 ofInvestigations 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 QfIuVestigafxons 600 Washington Street Boston,1u 02111 Tel.#617-727-4900 oA406 or 1-877rMASSAFF Revised 5-26-05 Fax#617-727-7749 www wass,gov/dia ( 'COMMONWEALTH OF MASSACHUSETTS; RP PF ELECTR`_ICIANS } ISSUES THE FOLLOWING LICENSE AS R,�GISTRED MASTER ELECTRIC:I:AN „ « TRE EL'ECTRI CAL CONTRACTORS tl N`C f) AIJTHONY A ROSH JR t W 60 PINE W UN I T l METIfiUEN ::< M/ 01844 683.2 , � ` 17434 A, ; 0X31/1:b 105408 , 1 Date.o2�//�!`Y....... 10332 of"OR7"'ti TOWN OF NORTH ANDOVER 3a;' ->::'• °oma 1 PERMIT FOR PLUMBING ♦ ,s » mu This certifies that.....................................-�T.. has permission to perform..........ti.:�.^.......................................................................►` . plumbing in the buildings of......... d P L.'".... e- at... yyz... '�f. -�).�` ................................North Andover, Mass. Fee,$.. -Lic. Nod /6 . ... Z'/%................................................................ PLUMBING INSPECTOR Check# Y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK II CITY nVG MA DATE L PERMIT# 10'W Z JOBSITE ADDRESS Z a OWNER'S NAME ILC POWNER ADDRESS TEL 11FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ] EDUCATIONAL D RESIDENTIAL:9 PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:Q PLANS SUBMITTED: YES® NO 01 FIXTURES 1 FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM—== DEDICATED GASIOILISAND SYSTEM I DEDICATED GREASE SYSTEM _,__1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I f FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) E _I _ -_ f . __._ I ._,___ I _ 1 r_ 1 ...._._i .jI f _.--..1 KITCHEN SINK i _. __1 ___I L___j __-_j LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL f __. WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING OTHER L INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO _ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW IC LIABILITY INSURANCE POLICY 5dj 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER El AGENT D SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the --- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i�� PLUMBER'S NAME r�=-- -- LICENSE# BbLUD SIGNATURE MP El JP R CORPORATION R1# PARTNERSHIP D# LLC COMPANY NAME �� t+1�, ��ADDRESS I JQ G CITY�,�_ - _-- --___..__�STATE ZIP TEL 4S)- 1 FAX CELL��EMAIL ' -------- - - ----- -- - -- - ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No �� l3 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ C4s 6C FEE: PERMIT# PLAN REVIEW NOTES i Date........... .............. ...................... Noarti TOWN OF NORTH ANDOVER : . PERMIT FOR GAS INSTALLATION This certifies that ...... ............ <. / (/ .e ...............................................;��- ............. has permission for gas installation ........�V-P�..J.......... ........... in the buildings of........... .. P .! ....... .. .C�........... ............................ North Andover,Mass. Fee ...".... Lic. No.-aO.0 .:... M ................................................ GASINSPECTOR Check# 133 a 10 5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT# IU JOBSITE ADDRESS OWNER'S NAME G , OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIALSIJ EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[-1 RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES 0 NO E] APPLIANCES 7 FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER m. .. .._ ... _ E I - I 1 EZJ BOOSTER - CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _ _ (�I _ I FRYOLATOR FURNACE GENERATOR GRILLE 1 �— L --- - —. _ _ --- •- - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT _ TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabifty insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES,o NO E 3 ., IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [)—!;Il 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 0 AGENT O 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 complian th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I _z —�J LICENSE# 1tx J SIGNA-�TURE MP 0 MGF El JP [5 JGF© LPGI© CORPORATION Q# PARTNERSHIP 0#=LLC®#I COMPANY NAME:E����i7h � �ADDRESS 1-�XrS -- CITY _ ^� STATE liZIP 015_ TEL 11 -FAX CELLEMAIL . ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No S �3 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r 1 '' r The Commonwealth of Massachusetts - Department of IndustrialAccidoints Office of Investigations 600 Washington Street Boston,MA. OZIII www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 11 Please Print Legibly Name(Business/Organization/Individual): M Address: �'� �� Duds ler City/State/Zip: (,,u,nn JA 01 1�0�1 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.2 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' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they a're 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 S elf-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 requiredunder 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. .d do hereby certifp under thepains anldpenallies ofperjury that the information provided above is true and correct. Simature: Date: Phone 9: 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.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 ofhire,`• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who,has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 CoRu onweatth of Massachusetts Department of Industrial,Accidents Office ofInvestigations 600 Washington Street Boston,MA.02111 Tel,#617-72.7-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-727-774.9 www mass,govAa 6 G�MMONWEALTH OF MASSACHUSETTS . . E PLUMBERS AND-GASFITTERS LICENSE , AS A JOURNEYMAN-PL UMBER ISSUES THE ABOVE LICENSE TO I KENNETH MARSHALL N 27 GREAT tWDODS TERR LYNN MA 01904 1619 j 3016.2 05/01/14 1839'64 Date...�I��.��. .................... o?' TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION t oma'.,' • �8 1 BACMU5� This certifies that .I UR. 9� V ................... ............................�.. ......... ........� !- has permission for gas installation ..:�1�. .... .�..n.,. ..... .. `1 t......... in the buildings of ..,... ..4.(.. at .......M6 Vit"......". .. ...............n............... North Andover,Mass. Fee....lb........... Lic. No. ��.� ............ J..:!' ?....................................................... �j GAS INSPECTOR Check# 4 �y .00340 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 5/29/2014 PERMIT# C1 � JOBSITE ADDRESS 305 Abbott St OWNER'S NAME Bob Corcoran OWNER ADDRESS 9 Whitney Rd North And TEL 1 617-512-3967 1 FAX 0 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Q TYPE OR pRM NEW.- RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESE] NOQ CLEARL-Y APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER . CONVERSION BURNER COOK TOP DIRECT VENT HEATER DRYER FIRE PLACE FRYOLATER FURNACE GENERATOR GRILL INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UI .T HEATER UNVENTED ROOM HEATER WAFER HEATER GAS PIPIING FOR 500 GAL LP TANK x INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES X] NO IF YOU HAVE CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X❑ 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 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 accu o the best my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nth all Pertine ovision of the Massachusetts State Plumbing Code and Chatper 142 of the General Laws PLUMBER-GASATTER NAME Timothy Surdam LICENSE 03-J SIGNATURE MP F] MGF❑ JP[:] JGF X❑. LPGI[:] CORPORATION X]# 164 PARTNERSHIP #OLLC F�# COMPANY NAME: F Lorden Oil Cc Inc ADDRESS: 69 Fitchburg Rd,PO Box 669 CITY: Ayer STATE: ® ZIP 1432 TEL: 978-772-2000 FAX: 978-772-5956 CELL: EMAIL: COMMONWEALTH OF MASSACHUSETTS BQARD'OF PLUMBERS".AND GASFITTERS ISSUES THE FDLLOWING LICENSE L I CN'SEC1 JOURNEYMAN GASF ITTE iQ iz TCMf1THY E SURDAM N 32 BEAVER 'ST trl. .*'ASH UA NH 03063-3 V. -- 2121 0._ 0 0.1 , r r) r}} pp G L C3 Date( /f. / ......... NORTH TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION F p h Cm This certifies that . , ' .�� .C.% v.^- r nT . . . . . . . has permission for mechanical installation .. . . . . . . . . . . . . . in the buildings of . .r a r� h ,�� , t, (L.. . . . . . . . . . . .. . . . . at . .. v . . .A�l 'rf . . '.T. . . - North Andover, Mass. Fee.F /.�.-7. . Lic. No.. . . . . . . . . . . . . . . . . . . . .. . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Jan. 31. 2.014 11 : 25AM Town of North Andover No. 1552 P. 1 L Commonwealth of Massachusetts Sheet Metal Permit �f Perm # 22, X bate: ' 1 L , S� 600. O© � S Estimated Job Cost: Permit Fee:$ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 90— 10 3(4285 . Applicant License# �Gt 22 Business Information: Property Owner/Job Location WOrrnation: Name: Name:�cAS'�' CL r a CLC . . . Street: City/Town: �_ t43_/u i� — CitYfrown: Telephone: �l�i-' Q=I�— Telephone: Photo I.D.required/Copy of Photo I.D. attached: 'YES—/- NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational_� Xnstitutional Building Cubic 1~ootage: under 35,000 cu.ft.I over 35,000 cu.ft, Sheet metal work to be completed: New Work: Renovation: HVAC Metal hoofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: t� �& UUM ` 9i c �`�OF`) 00 V- nxo Vz Jan. 31. 2014 11 : 26AM Town of North Andover No. 1552 P. 2 INSURANCE COVERAGE. I have a current liabilfty insurance policy or its equivalent which meets the requirements of M.G.L.Ch.412 YosNo❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAI 3.I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application-waives this requirement. Check One Only w Owner/ Agent ❑ Signature of Owner or Owner's Agent !! By oheck)ng this bo-01 I hereby certify that all of the details and information I have aubm Itted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 11 Z of the General taws. Plrogess Inspections Date Comments Final losipection Dak Comments Type of License. 3y ❑Master Cltte ❑Master-Restricted I ;ity/Cown ' Journeyperson 'ermit# Signature of Licensee QJourneyperson-Restricted 98� :es E License Number:_ (� El Check at www.mass.gov/dial 1Spector Signature of Permit Approval I � S Ew OCT 16- J a .. - 4a x 1, Rli-ill 21 r� S� f i r IMG-0755 IMG_0113 I � l r LEGEND w-r erq wa FAM_a C�II� �• ra ra ra Iv r-r rt r•rr ra�-e r-I r PORAVAS DESIGN& CONSULnNG 49 Appleton ftm F� Melrose.MA 02176 nul � o � L r11 " L Thon9-927-1579m�slgal(�gmaiLco Proposed r. I Vow Rcsidencv uv r{• 4 i �, o Iii ,••r' a Lot 1 303 AbbottStreer p 00 _._ ) N.Andover,MA a I maer p uy' +h• r.1 - R p , wag kRoomI sme,feeemn r N@ P—Itset --------------- ------------I L i � uOOYU DCnA/Oryar y L l{eme: ....._..�__._.._.._ ,...._.. � AI A{,•IJ2stAfeerPyyey YOM1 o-o-a NovmnhrB J0/3 1ZBV191011s: ReT M qte pA Y•P fi• I'•+h' Mfi' I-T I? �rl,{�p�� W cyi{• T•4 r>r I•T r{' ry .tlM l]1]M, ra /a M' f•e' Ya Ma r{ f M' {• T— I.— • a I LL hawing Number d FIRST FLOOR PLAN fl ALL LEGEND ® Y�erz.r PORAVAS DESIGN CONSULTING 49 Appleton Street o'•a aro (L, ,a�1{Z ` ` Melmac,MA 02176 r�• r•r r•1• �aCtl�_T 1 I v-r f-r ewk• Y-r ra 339-927-1579 _ E-MaIC ---tom----------- "-- —------------------ e+ r ED d "�V f New Ras euce at: i r } E Lot 1 303AbbottStreet N.Andover,MA LYOIr r+k Iveh• � I . ti r-n• r•ak I ¢ r+N x G tl I I TO AiIC UIOVd ��— L i II II I lih j i 80HU9 Ror,f1n. �.3 r ah' 1 � riY T•1 Su6mitletl fbf: I C jl C it �I p Rcele: I I 14LL a[Loo� P CA M•: CA P[evw � I � Plle Noma I I 4 � Al AYecumlFMv➢4naro II ' e it E II I Date: I Revisions: Rev N 1)rte awh' r-M' rak <N• r-a' 1'-a r•Ih• rt r-/k e'-1• e-a w•a LDmwin&Number 7 SECOND FLOOR PLAN u • e 1 /� 8 ro l 11.2 1 \\ I` \ a I i I I i L _�__. _._ _ __ _ _. _�-_ - __ __- - ..__ _� __ ,_ _ I r I , I AAL ley r �v �2 m� as ww a'�• ua• WI• H' UNPHOWD BASEMENT �� r AH.I y 11 1 IY•1• m-1• HIM tux m v-oA ro• BASEMENT FLOOR PLAN i'Z z� Date......1- .9..��..... / �►ORTF� TOWN OF NORTH ANDOVER PERMIT FOR WIRING 8`4,CHU3fc This certifies that................ ......................................... has permission to perform ........... .,,,.,,, the �/ wiring in e building of......................:. � -�/.�....... .. v � .......... ........ ...... at - &.7. ..........J .................... North Andover,Mass. Fee... L .........�Lic.No.I !,........... .a LGtiJ................ EL CTRICAL INSPECTOR. Cf4eck# 13�r6 12062 - ,. ; LEGEND a ® Burn& la-a na wa ! APA-c(^ /�1.4111 ry' ra .a as r•v J vy r. re ra r-r ra t1 PORAVAS egg DESIGN& CONSULTING 49 Appleton Sheet Melrose,MA 02176 Talephone: `G. n'----- - - ------ � 339-927-1579 Mr— J 11 ��1'• 7cJ 11� pdedellgn � oom 7' Nowiteridanceak w ry' 9 I o a Lot 1 303AbbotrStreat rya• Y•ya' oo N.Andover,MA 1•t F .r Gobi- aa' Na•L,y N T'In��I F ra• II ti N v!• y 4 8obmlead Nn ki 1-CA qpm laa•���oyr�eI��.�r ��) s P—ItSw I�i C � L Y!'X I• I e IH•-f-0• r------------ Down q 171 NYmY: raa� --- -- - - E este: Ditto: 0,3013 .ro • Revisions: R-N DY Ib 1-P d Ya Ia ry' no' 1'a Na ry' wa LL< DrawingNumber s FIRST FLOOR PLAN t7 cZ A1. 1 LEGEND ® 11re°raa`fblteDM PORAVAS �It DESIGN CONSULTING 49 Appleton Street Melrose,MA 02176 v-r r•T a•Ir• Oel* "�� 339-927-1579 i y�'j� 13vLfnlf: i .-__.-.---- " � ��11� pdtdesl�l®gmail.lwm k d T>1rIL UE4�j rq--d BEDR d /� w t '" / NewResidence at Lot I 303 Abbott Street N.Andover,MA ' Y-p r-0 r•1 >'• µWIT Swoon ��ppT��� "�® rrA• ve '� 11�R}3T vv r•n• r•,k 4 ¢ I II II v'noa' yya• Th sabtattm roe 4 ii 1 Z BEDR00m I I rn Wfr se esDRoon WlW� 1141'74' nad • I I 1 � BMW Dnwn MI I CArMnvu I I 1 N F A!tseeandrknrr/naaa II E Date: l_---_.. i I 4 Novembvl,lal! iZeV1910A9: Rev M Data m r•r r+ rx• rsA• I P.%. 1w r-a �h�? Wif' T•7R' Ti' FIX' N-v C-0' , �_ L Drawing Number U SECOND FLOc'OR PLAN � �AL, r. A 1 .2 I • i 1 LEGEND L - it `t!—�- m"'' /� � ♦� F ® ate rip 54 W i2 �G �� 28 m << PORAVAS DESIGN& f�a CONSULTING 49 Appleton street ■'•a ra a r a• Melrose.MA 02176 rdephona.• 339.927-1579 Ira dcda: i pdcdalgnl@peO.com Proposed No widence ea n � ® Lot 1 r p 303 Abbott Sheat M Andover,MA t - �'�-- UNFINISHED ATTIC R f L1iFMI9HEO BASEMENT � ® b k r rV6 4 yy��pptm���yy��Te�fpp♦� I�^,�J� �11� F IWI1A6l AeeWw � r ® h I' —����r�T 1 get SubOtit$ (m: i PmfOlt i i CAN—.. fY4' ye pr iim••'� tMA• tYy.• pq Fu.Nemo: �' Al!•nwmlAt✓kA�ye MtMYON1 AYLI 14 �.y ta•tr Date: L L< Naamb-4 4013 L L< Revislons: AnvM perm BASEMENT FLOOR PLAN AeTTIC PLS g Drawing Nwaber A1 .3 Commonwealth wealth of Massachusetts Official Use Only Department of Fire Services Permit No. r ® k Z, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.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 ININK OR TYPE ALL.INFORMATION) Date: / Z — / — ZD 1 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) 3a� &� Owner or Tenant L L Telephone No. Owner's Address GL/i Is this permit in conjunction with a buildin permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. I &p -zj I la Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service 1,0b Amps 100 /ZYO Volts Overhead, n grd No.of Meters 7 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /e ,42 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burgers No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: """ " " '"'"'. ""'"....." Detection/Alerting Devices No.of Dishwashers S ace/Area Heatin KW Local❑ Municipal F-1OtherSpace/Area g Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. { 'Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability,insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,lander the pains and penalties ofperjury,that flze information on this application is true and complete. FIRM NAME: y%eAr 0 zoni-�r 7,9—.r LIC.NO.: /7/.3 V /9- Licensee: Licensee: ,o Signature LIC.NO.: (Ifapplicable,entr"exe "irlthelicensenumberline.) Bus.Tel.No.•�yJ� ��9l Address: t n-t 119Alt.Tel.No.: 7106 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE.$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass(] Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments:, T 12 - 10 7- j Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts - Department oflndustrialAccidents Office of Investigations 600 Washington Street .Boston,MA 02111 www.mass gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r _ Please Print Legibly Name(Business/Organization/Individual): Address: (Vb ��- City/State/Zip: 0)(i,Q Phone Are y9"n employer?Check the appropriate box: Type of project(required): 1. am a employer with�_ 4• El ❑ I am a general contractor and I ' 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 2 ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers' comp.insurance. g• El Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 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.❑Roofrepairs • insurance required.]t employees.[No workers' 13.❑Other 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 aid 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 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:- `C tg U 1-e_� Policy#or Self-ins.Lic.#: Expiration Date: —Zb Job Site Address: SOS —City/State/Zip: /V j0r1dpcj-eel, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 sof 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. . c - ' do hereby certiryy undef1hepains and penalties ofperjury that the information provided above is true and correct Signature: 4,b Date: Z Phone#: 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-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 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 returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture ' (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, t ' please do not hesitate to give us a call. The Department's address,telephone and fax number: The Coxnmonwoalth of M-,gssarhusPtts - Department of Industrial Accidents Offlce of Investigations 600 Washington Street Boston?MA 02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax#617-727-7749 w�w.�n,ass,gevfc3aa Cornpan'y Info Name, East Gust Comfort LLC Address.252 Woburn street N Location, Wilmington , MA, 01887 Phone: 978-580-7021 Client Info :Building narnedescription. Contact name: Steve Coroorn Address:303 Abbott rd Location: North Andover, Massachusetts, United Stat... Phone: Load S uvn rna ryr Total building area: 1,340.0 SgFt Total coaling load: 43,+647.3 BTU Total coolingtonnage, 3.6 tams Total heating load: 56,+071 .8 BTUh Total airflow, 5,251.4 CFIVI ACOA-Approved Manual .t8 Calculations 12:38:15 02-03-2014 This software was developed by Carmel Software Corporation. It has been approved by RCCA for Manual 08 residential HVAC load calculations. Checksums - Cooling Total building area (SqFt): 1,020.0 Total building volume (CuFt): 8,160.0 Total cooling sensible load (BTUh): 40,256.2 Total cooling latent load (BTUh): 3,391.1 Total cooling load (BTUh): 43,647.3 Total tonnage (tons): 3.6 Total cooling infiltration airflow (CFM): 21.3 Total cooling ventilation airflow (CFM): 88.7 Total airflow (CFM,): 5,251.4 Total infiltration air changes/hr (ACH): 016 Sensible heat coefficient (SHG): 1.10 Latent heat coefficient (LHC): 0.68 Cooling load density (BTUh/SqFt): 42.79 Cooling airflow density (CFM/SqFt): 5.15 Cooling airflowAload (CFMrron): 1,443.8 Cooling area/load (SqFt/Ton): 280.4 Checksums - Heating Total building area (SqFt): 1,340.0 Total building volume (CuFt),. 10,720.0 Total heating load (BTUh): 56,071.8 Total airflow (CFM): 5,251.4 Total building air changes/hr (ACH): 29,39 Sensible heat coefficient (SHG): 1.10 Latent heat coefficient (LHC): 0.68 Heating load density (BTUh/SqFt): 41.8 Heating airflow density (CFM/SqFt): 3,92 ACCA-Approved Manual JO Calculations 12:38:15 02-03-2014 This software was developed by Carmel Software, Corporation. It has been approved by ACCA for Manual A residential HVAC load calculations. Block Load Breakdown -Cooling Description Value % Windows and glass doors: 33,132.7 75.9% Skylights: 0.0 0.0 Wood and metal doors: 0.0 0.0% Above grade walls: 772.9 1.8% Partition wails: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 704.8 1.6% Internal gain: 3,780.0 8.7% Duct heat gain: 0.0 0.0% Ventilation: 2,932.5 63% Blower heat gain: 0.0 0.0% Excursion adjustment load: 2,324.4 5.3% Total cooling: 43,647.3 100.0% Block Load Breakdown-Heating Description Value- fro Windows and glass doors: 40,383.8 72.0% Skylights: 0.0 0.0% Wood and metal doors: 0.0 0.0 Above grade walls: 3,435.2 6.1% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0%0 Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 5,645.9 10.1% Duct heat loss: 0.0 0.0% Ventilation: 6.606.8 11.8% Hot water piping load: 0.0 0.0% Winter humidification load: 0.0 0.0% Total heating: 56,071.8 100.0% ACOA-Approved Manual J8 Calculations 12:38:15 02-03-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. w I Room Heating and Cooling Totalis Room Warne Cooling Load (BTU# ) Heating Load (BTUh) Airflow (CFM) A Roomy 0.0 0.0 0.0. Totals 0.0 0.0 0.0 rACCA-Approved Manual A Calculations 12:3$*.15 02-03-2014 This software was developed by Carmel Software 'Corporation. It has been approved by RCCA for Manual J8 residential HVAC load calculations. System Block Load Breakdown -Goofing Windows,glass doors, skylights, 33,132.7 BTUh Envelope(walls, doors, roof,etc.): 772.9 BTUh Infiltration:'L-- —- -- 704.6 BTUh Internal gain:, 3,78D.0 BTUh Duct and blower heat gain: 0.0 BTUh Ventilation: -- — T 2,932.E BTUh Excursion adjustment load: 2,324.4 BTUh Total cooling: 43,647.3 BTUh System Block Load Breakdown- Heating i Windows, glass doors, skylights: 40,383.8.BTUh Envelope (walls,doors, roof,etc.): 3,435.2.BTUh Infiltration: 5,645. BTUh Duct heat loss: D.q BTUh VentilationAvinter humidification: 6,606.8 BTUh Hot water piping load: 0. BTUh Total heating: 56,071.8 BTUh RCCA-Approved Manual A Calculations 12:38:15 02-03-2014 This software was developed by Carmel Software Corporation. It has been approver!by ACCA for Manual A residential HVAC load calculations. 4 Company Info Name: East Coast Comfort LLC Address.: 252 woburn street Location: Wilmington , IIA, 01887 Phone: 978-580-7021 Client Info Buildings nameidescription: Contact name: Steve Corcom Address: 803 Abbott rd Locations North Andover, Massachusetts, United Stat... Phone: Load Summary Total building area: 1,650,0 SgFt Total cooling load: 44,112.8 BTUh Total cooling tannage: 3.7 tons Total heating load: 56,805.0 BTUh Total airflow; 5,275.5 CFNI N ACCA-Approved Manual J8 Calculations 12:52:18 02-03-2014 � This software was developed by Carmel Software Corporation. It has been approved by ACOA for Manual J8 residential HVAC load calculations. Checksums - Cooling Total building area (SgFt): 1,650.0 Total building volume (CuFt): 16,500.0 Total cooling sensible load (BTUh): 40,441.2 Total cooling latent load (BTUh): 3,671.5 Total cooling load (BTUh): 44,112.8 Total tonnage (tons): 3.7 Total cooling infiltration airflow (CFM): 56.4 Total cooling ventilation airflow (CFMi): 67.8 Total airflow (CFM): 5,275.5 Total infiltration air changes/hr (ACH): 0.20 Sensible heat coefficient (SHC): 1.10 Latent heat coefficient (LHC): 0.68 Cooling load density (BTUh/SgFt): 26.74 Cooling airflow density (CFM/SgFt): 3.20 Cooling airflow/load (CFMfTon): 1,435.1 Cooling arealload (SgFtfTon): 448.8 Checksums - Meating Total building area (SgFt): 1,650.0 Total building volume (CuFt): 16,500.0 Total heating load (BTUh): 56,805.0 Total airflow (CFM): 5,275.5 Total building air changes/hr (ACH): 19.18 Sensible heat coefficient (SHC): 1.10 Latent heat coefficient(LHC): 0.68 Heating load density (BTUh/SgFt): 34.4 Heating airflow density (CFM/SgFt): 3.20 RCCA-Approved Manual J8,Calculations 12:52:18 02-03-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations. i - I • Block Load Breakdown - Cooling Description Valu® % Windows and glass doors: 33,132.7 75.1% Skylights: 0.0 0.0% Wood and metal doors: 0.0 0.0% Above grade wails: 772.9 1.8%0 Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 1,863.3 4.2% Internal gain: 3,780.0 8.6%0 Duct heat gain: 0.0 0.0% Ventilation: 2,239.4 5.1% Blower heat gain: 0.0 0.0% Excursion adjustment load: 2,324.4 5.3% Total cooling: 44,112.8 100.0% Block Load Breakdown-bleating Description Value % Windows and glass doors: 40,383.8 71.1% Skylights: 0.0 0.0% Wood and metal doors: 0.0 0.0% Above grade walls: 3,435.2 6.0% Partition walls: 0.0 0.0% Below grade walls: 0.0 0.0% Ceilings: 0.0 0.0% Floors: 0.0 0.0% Infiltration: 7.940.8 14.0% Duct heat loss: 0.0 0.0% Ventilation: 5,045.2 8.91/o Hot water piping load: 0.0 0.0% Winter humidification load: 0.0 0.0% Total heating: 56,805.0 100.0% ACCA-Approved Manual J8 Calculations 12:52:16 02-03-2014 This software was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations, i i Room Heating and Cooling Totals Room Name Cooling Load (BTUh) Heating Load (BTUh) .Airflow (CFM) A Froom 0.01 0.01 0,0 Totalis 0.01 0.01 0.0 ACOA-Approved Manual. A Calculations 12:5215 02-03-2014 This software was developed by Carmel Software Corporation. It has been approved by RCCA for Manual A residential HVAC load calciulabons. System Block Load Breakdown-Cooling i Windows, glass doors, skylights: 33,1327 BTUh Envelope(walls, doors, roof,etc.): 772.9 BTUh Infiltration: - 1,863.4 BTUh Internal gain: 3,780.0 BTUh Duct and blower heat gain: 0.0 BTUh Ventilation: - 2,239.BTUh Excursion adjustment load: 2,324.4 BTUh Total cooling: 44,112.8 BTUh System Block Load Breakdown- Heating Windows, glass doors, skylights: 40,383.1 BTUh Envelope (walls, doors, roof,etc.): 3,435.2'BTUh Infiltration: 7,940.8 BTUh Duct heat loss:' 0.0 BTUh Ventilation/winter humidification: 5,045.2 BTUh Hot water piping load: - 0. BTUh Total heating: 56,805.0 BTUh RCCA-Approved Manual A Calculations 12:52:18 02-03-2014 This sottware was developed by Carmel Software Corporation. It has been approved by ACCA for Manual J8 residential HVAC load calculations.