Loading...
HomeMy WebLinkAboutMiscellaneous - 315 TURNPIKE STREET 4/30/2018 (8)k ILI c Date . `JA Z..I1'5......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING fiK! � �% d -2.VN1 A,,J This certifies that...............................y..... �............. has permission to perform. .................. p. e!!`....... ......................... m �, Q B i+M plumbingthe buildings of..........:�........................................................................ at ...1..`��. 1( Q �?�''�:`-�......... ......, North Andover, Mass. Fee . i tA `... Lic. No. h..[� .. ............................................................... 144b] i ~ PLUMBING INSPECTOR Check # WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _ _ ,1/ INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES F NO 0,1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Q BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliant all Perti nt prov' on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L ._� ���� S "'_ ___ 1 -LICENSE # ll l SIGNATU E MP M JP 0 CORPORATION M PARTNERSHIP M# #L'LLC r- ---� COMPANY NAME ADDRESS CITY �" " 14 �N®a STATE r ZIP 0/f '/TEL G.� 9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4► Uw POWNER TYPE OR PRINT CLEARLY CITY �� _ MA DATE c? J PERMIT # 6 JOBSITE ADDRESS OWNER'S NAME I,,4��C wGG�s ADDRESS- ' TEL 9 h y 9 FAX OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL RESIDENTIAL �I] NEW: RENOVATION: © REPLACEMENT: PLANS SUBMITTED: YES � No Ell FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM { ._ i ___.._.1 .__.._.._{ (� _, i _ _ 4j ___ --_ ► ! _.—� f i __.. # ._ 1 f ( _._ .{ _I _{ DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAV , ORY_. ROiDRAIN IF _ ..__.__.f i SHOWER STALL SERVICE / MOP SINK ._ .1 l _{ _. _ _{ ! ._ __.I ( ._,_k TOILET 1 _ F= — URINAL .� f ! _._� r-11 __--. --__.� ....__r[ ___.._.� 1 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER _ _ ,1/ INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES F NO 0,1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Q BOND D OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliant all Perti nt prov' on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME L ._� ���� S "'_ ___ 1 -LICENSE # ll l SIGNATU E MP M JP 0 CORPORATION M PARTNERSHIP M# #L'LLC r- ---� COMPANY NAME ADDRESS CITY �" " 14 �N®a STATE r ZIP 0/f '/TEL G.� 9 4 41w orl z N ❑ Ix ui w LL �I n m N i p D v p ET c rD fD < v ' ; d — om. Nn m d i Q (DD N O N N O rD O N O O �., f1 (D Cn U Ln O v rD On Q rD fD M rD N fi O r O n ) r O f7 Z O Z rD L + rD s� D O < r�o to D o > O N N N N O (n Ln Ln 0 O O O O O O Oh O O O O O rD Z a O r r r ' D � > Q sO L < D 3 ' v > Q t. The Commonwealth of Massachusetts Department of IndustrialAccWnts Office of Investigations 600 Washington Street Boston, MA 02111 UT www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/fndividual): Areyou an employer? Check the appropriate box: 1. XI am a employer with /� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. T ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] • Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition f 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. f 9'lumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T 'Homeowners who submit this affidavit indicating they are 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. A. , 01 r _ Insuranc Policy # Job Site Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). C� (VE-) 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. I do hereby certify.under th,� e paiinnss/and penalties ofperjury that the information provided above is true and correct Siunafiire- �G2 ,.� 7� '^^� Date: / k / 1-5- 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 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 full in the permithicense 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, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth ofMassachwetfs Department ofindustrial Accidents Office ofInvestigaliou 600 Washingto>a Street Boston, MA 02111 TO. # 617-727-4900 eyt 406 or 1-877:MASSAFE Revised 5-26-05 Fax # 617-727-7749 wWWaMass,govaa WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Information- Page Independence Casualty Insurance Company NCCI Co. No.: 36835 Policy Number: WC100078406 1. INSURED: Prior Policy Number: WC100078405 Merrimack College Producer: C/O Michael Magner HUB International New 315 Turnpike Street Federal ID Number:042103731 England, LLC 299 Ballardvale Street North Andover, MA 01845 Risk ID Number: 913378938 Wilmington, MA 01887 Business Type: Corporation SIC:999999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 1/1/2015 To 1/1/2016 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states lis here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $561 $38,673 Interim Adjustment: Annually Servicing Office: 25 New Chardon Street Boston, MA 02114-4721 Issue Date 12/19/2014 Copyright 1967 Total Estimated Premium Surcharge(s) Retro Minimum Premium 60% Total Premium and Surcharge(s) Countersigned By:_ �' �; w; llefi4- Council on Compensation Insurance $222,311 16,442 $126,303 $238,753 Form: 100m Independence Casualty Insurance Company Workers Compensation and Employer's Liability Insurance Policy Extension Schedule Policy Number WC100078406 MA -20 Insured Merrimack College WC 00 00 01 Classifications Code No. Premium Basis Total Estimated Annual Remuneration Rate Per $100 of Remuneration Estimated Annual Premium No. of Employees From 1/1/2015 To 1/1/2016 Increased Employers Liability 2% 5,274 Subject Premium 268,981 Drivers And Helpers-NOC-Commercial 7380 26,000 6.17 1,604 0 School -Professional Emp & Clerical 8868 35,500,000 0.67 237,850 0 School -A/0 Employees 9101 2,700,000 3.34 90,180 0 form 101 m 820001 (01-88) Manual Premium 329,634 9037 Deviation Credit -20% (65,927) 0000 Increased Employers Liability 2% 5,274 Subject Premium 268,981 9898 Exp. Modifier 0.86 (37,657) 9999 Modified Premium 231,324 Standard Premium 231,324 0063 Premium Discount 9.00% (20,819) Normal Premium 210,505 0900 Expense Constant 338 9740 Terrorism Act Surcharge 11,468 Total Estimated Premium $222,311 DIA Assessment 16,442 Total Premium and Surcharge(s) $238,753 form 101 m 820001 (01-88) WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Extension Schedule WCE-10 Independence Casualty Insurance Company Policy Number WC100078406 Insurer Independence Casualty Insurance Endorsement Effective Date: 01/01/2015 Insured Merrimack College The Policy Period Is From: 1/1/2015 To 1/1/2016 Schedule of Endorsements: WC 00 00 CV Policy Cover Letter WC 00 00 01 A Extension Schedule for Class Codes WCE-107 Extension Schedule for Locations WCE-110 Installment Schedule WC 00 04 03 Experience Rating Modification Factor Endorsement WC 20 03 01 Massachusetts Limits of Liability Endorsement WC 20 03 02 A MA Assessment Charge A WC 20 03 16 MA_Employers Liability Insurance Endorsement WC 20 03 03 D MA Massachusetts Notice to Policyholder Endorsement_D WC 00 04 14 Notification of Change in Ownership Endorsement WC 20 04 01 MA —Massachusetts Pending Premium Change Endorsement WC 20 06 01 A MA_ Massachusetts Cancellation Endorsement WC 20 03 06 B MA_WC20030613Massachusetts Limited Other States Insurance WC 20 00 EP Employer Poster WC 00 04 06 Premium Discount Endorsement WC 99 06 89 Repatriation Endorsement WC 99 03 16 Foreign Voluntary Compensation and Employers Liability Coverage WC 20 01 01 WC2001 01 -Terrorism Risk Insurance Extension Act Endorsement WCE-207RPE Retention Premium Endorsement WC 20 0102 WC200102 - Mass Notification Endorsement of Pending Law Change Issue Date 12/19/2014 Page 1 of Last Form: 105 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Extension Schedule Independence Casualty Insurance Company Insured DBA Name Policy Number WC100078406 Endorsement Effective Date: 01/01/2015 The Policy Period Is From: 1/1/2015 Schedule of Locations: Massachusetts Merrimack College 315 Turnpike Street North Andover, MA 01845 FEIN: 042103731 To 1/1/2016 Insurer Independence Casualty Insurance Company Insured Merrimack College C/O Michael Magner 315 Turnpike Street North Andover, MA 01845 Issue Date 12/19/2014 Page 1 of Last Form: 107M 1/12/2015 Division of Professional Licensure: License Search T6-, Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) 10 Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: RANDY L. SIDEMAN LOWELL, MA NEW SEARCH Licensing Board: PLUMBERS £t GASFITTERS License Type: MASTER PLUMBER License Number: 10149 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: 6/13/1985 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, January 12, 2015 at 11:25:42 AM. © 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http://license.reg.state.ma.us/public/pubLicenseQ.asp?board code=PL&type class=_M&license number=000010149&color=&Ib=PL 1/1 t. Date ..... Z�.17 .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... has permission for gas installation .... ,A- 2015 ................... in the buildings of ..... ........................ )�� ............................ ... ........................... at &.5 ...... ............................. . North Andover, Mass. Fee.)..�! Lic. No. N.9� ....... MDr .................................................... Check# 1400,,� GAS INSPECTOR ^ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY d RU. MA DATE -1 - PERMIT # �-1 JOBSITE ADDRESS j S 7�,-!/��' _ OWNER'S NAME �%1 ��fP/A!A GOWNER ADDRESS DTE 1i 9:79,5-Y V LZ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [ RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: ® REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO0 APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ Iy -. __ - -1 . � .._ . _ Cir DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR(I_ GRILLE INFRARED HEATER�- LABORATORY COCKS MAKEUP AIR UNIT _ (�4 OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNIENTED ROOM HEATER WATER HEATER -1 .__. OTTER - -.. - - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES IEINO D I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW - LIABILITY INSURANCE POLICY [D OTHER TYPE INDEMNITY E] 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 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and accurate to the best 9f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ' h all Pertinent pr isio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME -`�! L'` -/"1q ^� _. - LICENSE # d/ S N URE MP Ul"MGF 0 JP JGF [I LPGI CORPORATION Q# PARTNERSHIP ©#= LLC ®#= COMPANY NAME: ADDRESS VXWledF CITY STATE ]ZIPJQI y]TEL FAX CELL 7� l _q/01 -EMAIL MA -- - - /)-a )D 0 1117-115 VZf C, CA V� -1 \rn4A " rs- H O z 0 H U w P-4 W s a of Z ONr-I W } � W OF CL U w �* z w 3 4 a w a O w w w w U a a oLn a a U J ' F M LL � w x w H- w W F zz 0 H U W V) U ' C4 v. r) .W N" -f O �D v fD =3 v rt 7 N �.: N M _ v N (� CL CL N to N Ln cu F -A,••.< . C,, �. O a I" Q,. N O' o = o m' n.: fD ' car+ Wo v� M 3 �.... `r O h. On; c Z, _. o, �•; oa 0o :.: D N O O CL ` O: (/) < .,4 !� �4j*)-tnV). fD O N N N N N O Ln 0 In Ln O O 'O O O O w."O`' 'c't O O O O Ln O O O O O Z O ' rF D O N ` to V •. F C (D' D 3 C M M 3 rF Z O U 0 n Q The Commonwealth of lllassachusetts Departm ntoflndicstriglAceie%nts Office oflnvestigadons 6#0 Washington Street .Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIf AnnUpnni 7nfarmatinn .u - Uri City/State/Zip: Are your an employer? Check the appropriate box: Type of project (required): I am a employer with � 4. ❑ I am a general td i contractor an 6, ❑ New constxucizon employees (full and/or pari -time) 2. [] I am a sole proprietor or parinex- have hired the sub -contractors listed on the attached sheet. 7• F] Remodeling ship and'lave no employees working forme in any capacity. These sub -contractors have workers' comp. insurance. 8. ❑ Demolition 9. ]] Building addition [NO workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised.their 1011 Electrical repairs or additions required.] 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), andwehaveno 12.[] Roofrepairs bsurancerequixed.] i employees. [No workers' 13.1 Other . f comp. insurance required.] *Any applicantthat checks box*1 must also fill outthe section below showing their workers' compensation policy information. 'Homeowners who submit this affidavit ind catingthey kdoing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached au additional sheet showing the name of the sub -contractors and their workers' comp. policy information. f am an emyloyer that / is providing workers' cornpexassation insurance for nzy employees Below is th(mMA alicy andjoh site infoi'matlon. t A , f n ' .. / - � ,. , , ! --A - r n A Ae' �V All A n I— i- i / . fi insurance Company N policy # or Self, hs. Lic. #: ��� __ ExpiraizonDate: �`� City/State/Zip rob Site Address: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as xeguI dander Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties i a the form of a STOP WORM ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certzjy under the pains and penalties of perjury that the information provided above is true and correct. - Signature: Date: phone #: Official use only. Do not write in this area, to be compieted by city or town official. City or Town: Permit/.License # Issuing Authority (circle one): 1. Board of Health 2. BuildingDepartment I City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: it 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 employeris defined as "an individual, partnership, association, corporation or other legal entity, or anytwo or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee o`f 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, MOL 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 chapterhave been presented to the contracting authority." Applicants Pleas.0.0 out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) nam.e(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 notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees,apolicyisrequired. Be advised thatthisaffidavit maybe submitted tothe Department of .iudusirial Accidents for confirmation of iusurauce 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 ox if you are required to obtaia a workers' compeusationpolicy, 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 apph r,aat. Please be sure to 1711 in the pemsit/Iicense numbex which will be used as a reference number. In addition, an applicant thatmust submitmultiple 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 proo£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 orpermit to burry leaves etc.) said person is NOT required to complete this affidavit. The Office of l'nvesggations would like to thank you in advance for your cooperation and should you have any ciuesgons, please do not hesitate to give us a call. The Department's address, telephone aiid fax number: The Co ojiwoal&ofY'as�arhvsPtts - DOPartMent off du aX (ffke ofWostfga-ftn�a 6bG WashiVon Stcut �o�ion� QRZ � x Revised 5-26-05 `ay, 617-727-7749 WWW_MQ%g4v1ciia. WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Information_ Page WC 00 00 01 NCCI Co. No.: 36835 1. INSURED: Merrimack College Independence Casualty Insurance Company Policy Number: WC100078406 Prior Policy Number: WC100078405 C/O Michael Magner 315 Turnpike Street North Andover, MA 01845 Business Type: Corporation Other Named Insured: Federal ID Number:042103731 Risk ID Number:913378938 SIC:999999 Other Work Places: Producer: HUB International New England, LLC 299 Ballardvale Street Wilmington, MA 01887 NONCLASSIFIABLE ESTABLISHMENTS See WCE107 2. POLICY PERIOD: The Policy Period Is From: 1/1/2015 To 1/1/2016 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states lis here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $561 $38,673 Interim Adjustment: Annually Servicing Office: 25 New Chardon Street Boston, MA 021144721 Issue Date 12/19/2014 Total Estimated Premium Surcharge(s) Retro Minimum Premium 60% Total Premium and Surcharge(s) Countersigned By:_ Copyright 1987 National Council on Compensation Insurance $222,311 16,442 $126,303 $238,753 Form: 100m WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Extension Schedule WCE-106 Independence Casualty Insurance Company Policy Number WC100078406 Insurer Independence Casualty Insurance Endorsement Effective Date: 01/01/2015 Insured Merrimack College The Policy Period Is From: 1/1/2015 To 1/1/2016 Schedule of Endorsements: WC 00 00 CV Policy Cover Letter WC 00 00 01 A Extension Schedule for Class Codes WCE-107 Extension Schedule for Locations WCE-110 Installment Schedule WC 00 04 03 Experience Rating Modification Factor Endorsement WC 20 03 01 Massachusetts Limits of Liability Endorsement WC 20 03 02 A MA_Assessment Charge A WC 20 03 16 MA_Employers Liability Insurance Endorsement WC 20 03 03 D MA Massachusetts Notice to Policyholder Endorsement_D WC 00 04 14 Notification of Change in Ownership Endorsement WC 20 04 01 MA —Massachusetts Pending Premium Change Endorsement WC 20 06 01 A MA_ Massachusetts Cancellation Endorsement WC 20 03 06 B MA_WC20030613Massachusetts Limited Other States Insurance WC 20 00 EP Employer Poster WC 00 04 06 Premium Discount Endorsement WC 99 06 89 Repatriation Endorsement WC 99 03 16 Foreign Voluntary Compensation and Employers Liability Coverage WC 20 01 01 WC2001 01 -Terrorism Risk Insurance Extension Act Endorsement WCE-207RPE Retention Premium Endorsement WC 20 01 02 WC200102 - Mass Notification Endorsement of Pending Law Change Issue Date 12/19/2014 Page 1 of Last Form: 105 � WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Extension Schedule WCE-107, Independence Casualty Insurance Company Insured DBA Name Policy Number WC100078406 Endorsement Effective Date: 01/01/2015 The Policy Period Is From: 1/1/2015 To 1/1/2016 Schedule of Locations: Massachusetts Merrimack College 315 Turnpike Street North Andover, MA 01845 FEIN: 042103731 Insurer Independence Casualty Insurance Company Insured Merrimack College C/O Michael Magner 315 Turnpike Street North Andover, MA 01845 Issue Date 12/19/2014 Page 1 of Last Form: 107M 1/12/2015 Division of Professional Licensure: License Search The Officio I Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: RANDY L. SIDEMAN LOWELL, MA NEW SEARCH Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER License Number: 10149 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: 6/13/1985 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, January 12, 2015 at 11:25:42 AM. © 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http:/Aicense.reg.state.ma.us/public/pubLicenseQ.asp?board code=PL&type_class=_M&license_number=000010149&color=&Ib=PL 1/1 .91 Date................�............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thai� �� �.................�.W has permission to perform ?-��.'`� (� wining in the bulling of..... e 1, N) ! .....................fl --e' � ....'. �t �:�lc- ...............' a:... r...... �.......................... ............ ......: ...............r'North Andover, Mass. ,Fee ..... 1 P!9 ...... Lic. No......�D ! !� ELECTRT .. . INSPECTOR �4 o�j ICAL INSPECTOR 1/ Check # (/ 0 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Permit Fee Assigned . 11/99] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Pse the standard form only. (PLEASE PRINT IN INK OR TYPE ALL�INFORMAT N) Date: /d—//7 // City or Town of: of l l7, //�/1 --4L— To the f o Ins ecto ire': r By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution ?I - Address A Location and Nature of Proposed Electrical Work: s w, NOTE: C. 143 §31, of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by fling this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES ❑ NO ❑ This option is available where so contemplated by the municipality. In these cases, you must renew this application annually, and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional tog 7 .. th- Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers' or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: © Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. J1 �,(�-.L (Please see reverse side for certifications and required signature.) Institutional Permit Form, page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the. standard form for such work. Do not include such em- Wovees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. My title is:_✓//( tCl- & C My authority to act for the aforementioned institution is: M I certt&, under the pains andpenalties ofperjury, that the information on this application is true and complete. AL(Signature) (Dated) b2VI (Print na ) ie (work telephone number) ?/a'- j?37:. (extension), 3 j facsimile number) zl?j— L3 Z " ocZ,q 3 � Q C) W m --j O" D A ti (D =rv n O C < 1 rt d O Q a- (D (D O N N O O O (D ' r+r+CL n O F. (J'I F-& VI Ui l!1 �. (DD v N Owl O Q 1V O'+ 3 a aq 00 3 (D fD O 0- N 0 N N O N O N n M u� z + 0 0 W C. O(D _ ,-`+ ((DD Oro D O Q- O cn < c rD 4j,)- D a F,0 (D O N N N N N O w w w 0 O O O O O O 0h O O O O O O O Z ` O Z O * D D C- 0 Q < 0 rD D � (<D 3 O N 00 Ln p The Commonwealth of Massachusetts , Department of XndmtriglAccidints UqVoffice of Investigations 600 Washington Street .Boston, MA 02111 LT -9 www.mass.gov/dia Workers' Compensation bsuxance Affidavit: SniXders/Cont°actors/Electr icians/Plihnbers A lieant 7nformaiion Please Prim Legibly Name (EusinessFOrganzzaiion/IndMdual). ArirlrP,e' ;� 1b -fur nc4l City/State/Zip: Phone It: q�S-- 83 7r6cD . Are you an employer? Check the appropriate boa: 1.1 am. a employer with �4 4. � p � a general contractor and - employees (full and/or part-time).* have lured the sub -contractors listed on the attached sheet 2. ❑ I aim a sole proprietor or partner- ship and`have na employees These sub -contractors have working for mein any capacity. workers' comp. insurance. 5• ❑ We are a corporation and its [go workers' comp. insurance Officers have exercised.iheix required.] 3. El am ahomeowner lining all work right of exemptionperMGL myself [No workers' comp. c. 152, §1(4), and we have no in.surancerequixed.l ; employees. [No workers' comp. insurance required.] Type of project (required): 6, [] New construction. f 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.gElectrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roofrepairs 13.[] Other !Any applicant that checks box#1 must also fill outthe section below showingiheirwo&m' compensationpoHcy infomiafion. i Homeowners who submitthis affidavit indicating thek 9re doing all worleand then hire outside contractors must submit a new affidavit mdieatiug suc& tContraetors that che&tbh box must attached as additional sheet shov&gthe name of the sub -contractors and their workers' comp. policy infomuation. X am an emy%yet• that isp�ovlftg workers' compensation insurance forms employees Below is the policy andlob site information. .A : , . % _ P 1 I—. i, ' CA I nr, A/1tj 0&W VN in r I insurance Company Policy #orSelf ins. no. ��d�Q�'(? `t" ExpirationDate:, fC?I Job Site Address: �� City%State/Zip: I V . tEaeh a copy oft tTte woriters' compensation -policy declaration page (showing the policy nm ober and expiration date), dl Faihue to secure coverage as requiredunder Section 25A ofMCL o.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year impriso�unent, as well as civilpenalties 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. X do iereby cert& Urdu thepains an penalties ofperrary Mat the information provided above is true and correct. - /' J �� Li Date: 6 S Qianafi�rA• !N ���/�L�.... Phone # / 7e �5q Official use oitly. 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. Cityt /Town Clerk 4. Electrical Inspector 5. PlumbingZuspectox 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 tri the service of another under any contract ofhire,- express orimplied, oral orwriiien." An ernploydis 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 employex or 146 receiver or trustee of an individual, partnership, association or other legal entity, employing employeeHowever the he owner of a dwelling house having not more than three apartments and who resides therein, or the occupant However 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 mployer"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 anv of its political subdivisions Shan enter into any contract for the performance ofpubiic work until* cceptable evidence of compliance with the insurance requirements of this chapter have b con presented to the contracting authority." Applicants Please,fill out the workers' compensation affidavit completely, by checldng the boxes fliat apply to your situation and, if necessary, supply sub-confractor(s) name(s), address(es) and phone number(s) along with their certidcate(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, apolicyisxequired. Be advised thatthi affidavit maybe submitted tothe Deparknento£Industrial Accidents for confimnation 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 pe'nit 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' compensationpolicy, 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 Offiic0 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 that2.ust submitmultiple perm license applications in any given year, need only submit one affidavit indicating current Policy information (ifnecessary) and under "J'ob 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 cit,,. or to ; :m may be provided to the applicant as proof that a valid affzdavit•is on file for future permits or licenses. Anew 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. ad og license orpermit to burn leaves eta.) 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 Depatiment's address, telephone and fax number: ` `hey Commoilweajth of ?s�a�hv.:SPitS DepaftQ11l ofIndu al .Auddenta Off toe OffAvesiigavoAa X00 �as�.gkai�. �ree� Boston, MA 021 It Tel # 617-7-2Z-4900 (3A 406 ox X-87.7,MASS�� Revised 5-26-05 Fax # 617"727'7749 v+wwaaagovlch'a _ WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Information Page Independence Casualty Insurance Company NCCI Co. No.: 36835 Policy Number: WC100078406 1. INSURED: Prior Policy Number: WC100078405 Merrimack College Producer: C/O Michael Magner HUB International New 315 Turnpike Street Federal ID Number:042103731 England, LLC North Andover, MA 01845 Risk ID Number:913378938 299 Ballardvale Street Wilmington, MA 01887 Business Type: Corporation SIC:999999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured: Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 1/1/2015 To 1/1/2016 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $561 $38,673 Interim Adjustment: Annually Servicing Office: 25 New Chardon Street Boston, MA 021144721 Issue Date 12/19/2014 Copyright Total Estimated Premium Surcharge(s) Retro Minimum Premium 60% Total Premium and Surcharge(s) Countersigned By:_ �-VQI,-,j-W; flet- National Council on Compensation Insurance $222,311 16,442 $126,303 $238,753 Form: 100m Independence Casualty Insurance Company Workers Compensation and Employer's Liability Insurance Policy Extension Schedule Policy Number WC100078406 MA -20 Insured Merrimack College WC 00 00 01 Classifications Code No. Premium Basis Total Estimated Annual Remuneration Rate Per $100 of Remuneration Estimated Annual Premium No. of Employees From 1/1/2015 To 1/1/2016 Increased Employers Liability 2% 5,274 Subject Premium 268,981 Drivers And Helpers-NOC-Commercial 7380 26,000 6.17 1,604 0 School -Professional Emp & Clerical 8868 35,500,000 0.67 237,850 0 School -A/O Employees 9101 2,700,000 3.34 90,180 0 form 101 m 820001(01-88) Manual Premium 329,634 9037 Deviation Credit -20% (65,927) 0000 Increased Employers Liability 2% 5,274 Subject Premium 268,981 9898 Exp. Modifier 0.86 (37,657) 9999 Modified Premium 231,324 Standard Premium 231,324 0063 Premium Discount 9.00% (20,819) Normal Premium 210,505 0900 Expense Constant 338 9740 Terrorism Act Surcharge 11,468 Total Estimated Premium $222,311 DIA Assessment 16,442 Total Premium and Surcharge(s) $238,753 form 101 m 820001(01-88) WORKERS` COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY I Extension Schedule �ry N �A WCE40i Independence Casualty Insurance Company Policy Number WC100078406 Insurer Independence Casualty Insurance Endorsement Effective Date: 01/01/2015 Insured Merrimack College The Policy Period Is From: 1/1/2015 To 1/1/2016 Schedule of Endorsements: WC 00 00 CV Policy Cover Letter WC 00 00 01 A Extension Schedule for Class Codes WCE-107 Extension Schedule for Locations WCE-110 Installment Schedule WC 00 04 03 Experience Rating Modification Factor Endorsement WC 20 03 01 Massachusetts Limits of Liability Endorsement WC 20 03 02 A MA Assessment Charge A WC 20 03 16 MA_Employers Liability Insurance Endorsement WC 20 03 03 D MA Massachusetts Notice to Policyholder Endorsement_D WC 00 04 14 Notification of Change in Ownership Endorsement WC 20 04 01 MA —Massachusetts Pending Premium Change Endorsement WC 20 06 01 A MA_ Massachusetts Cancellation Endorsement WC 20 03 06 B MA_WC200306B Massachusetts Limited Other States Insurance WC 20 00 EP Employer Poster WC 00 04 06 Premium Discount Endorsement WC 99 06 89 Repatriation Endorsement WC 99 03 16 Foreign Voluntary Compensation and Employers Liability Coverage WC 20 01 01 WC2001 01 -Terrorism Risk Insurance Extension Act Endorsement WCE-207RPE Retention Premium Endorsement WC 20 0102 WC200102 - Mass Notification Endorsement of Pending Law Change Issue Date 12/19/2014 Page 1 of Last Form: 105 ' WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY I Extension Schedule SCE -,1 Independence Casualty Insurance Company Insured DBA Name Policy Number WC100078406 Endorsement Effective Date: 01/01/2015 The Policy Period Is From: 1/1/2015 Schedule of Locations: Massachusetts Merrimack College 315 Turnpike Street North Andover, MA 01845 FEIN:042103731 To 1/1/2016 Insurer Independence Casualty Insurance Company Insured Merrimack College C/O Michael Magner 315 Turnpike Street North Andover, MA 01845 Issue Date 12/19/2014 Page 1 of Last Form: 107M 1/12/2015 Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: JOHN R. DEMATTEIS Business: DEMATTEIS ELECTRIC WESTFORD, MA NEW SEARCH "This Licensee has additional Licenses click here to view them." Licensing Board: ELECTRICIANS MASTER ELECTRICIAN License T Type: TYPE CLASS: A License Number: 12476 Status: CURRENT Expiration Date: 7/31/2016 Issue Date: 9/26/1988 Exam Date: 8/6/1988 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday, January 12, 2015 at 11:24:55 AM. © 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes http:Micense.reg.state.ma.us/public/pubLicenseQ.asp?board code=EL&type_class= A&license_number=000012476&color=&IIrEL More... Site Policies Contact Us Date ..... // !/I � ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ),`. .....D...... ...-.. AIVA, � eA *� .................................. ele has permission to perform e ..................... ............................................................... ((— wiring in the building of......;.`!. . . .... A.0 ............ ............... & ............. orth Andover, Ma ................. .................. S. Fee.oe.�? .............. Lic. No. ..... . ............... . ............... .. ..... ........ ELEMICAL INSPECMR Check # V2 1 0 "�� 121 GO Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS tOfficial Use 0 Permit No. Permit Fee Assigned Lev. 11/991 (leave b1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/ 7 /14 City or Town of. North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution Merrimack College Address 315 Turnpike Street, North Andover, MA 10845 Location and Nature of Proposed Electrical Work: NOTE: C. 143 §31, of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ We will maintain one or more contemporaneous log(s) (check one): This option is available where so contemplated by the municipality. and upon significant changes in employment. NO ❑ YES ❑ NO i( In these cases, you must renew this application annually, The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. flttach sunnlementaru she.Pte if required for nrlrlitin"nl Ina In�ntinv,c Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 13 Full-time equivalent electrical employment: 3 How many helpers' or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: C� Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 0 —Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) 4 Institutional Permit Form, page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the. standard form for such work. Do not include such em- ployees in this application. /I Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention o�Mass� Electrical Code. My title is: V My authority to act for the aforementioned institution is: I certify, under the pains and penalties of perjury, that the information on this application is true and complete. (Dated)„ / "1(Dated)�� (work telephone number) (extension) (facsimile number) - The Commonwealth ofMassachusetts - Department of Industrial Accidents 62 Office of Investigations 600 Washington Street Boston, MA 02.111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Plumbers Applicant Information Please Print Legibly. Name (Business/OrganizationAadividual): Merrimack College Address: 315 Turnpike Street City/State/Zip: North Andover, MA 01845 phone (978)837-5144 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/orpari-time)" have hired the sub -contractors 2. El am a sole proprietor or partner- listed on the attached sheet. x 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9• D 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. E] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roofrepairs insurance required.] ► 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 lt,meowners who submit this affidavit indicating they sire 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 thepolicy and job site information. Insurance Company Name:. Atlantic Charter Policy # or Self -ins. Lic. 9: WC 10 00 7 8 4 0 3 Expiration Date: l / 1 / 14 — 1/1/15 Job Site Address: 315 Turnpike Street. City/State(Zip: No. Andover, MA 01845 Attach a. copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as regal redunder Section 25A of MGL o.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 cert1,fAft#1thJpa1ns ancd perms of perjury drat the information providetd above is true anti correct Phone M 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. EIectrical inspector 5. Plumbing Inspector 6. Other - - - r t ------ '01, 'D1, --.4f. Information and -Instructio- 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 ofhire,- express or implied, oral or wzitten." 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 Ideal 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) andphone number(s) along withtheir 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 au LL C 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 ofinsurance 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 onto appropriate line. City or Town Officials Please be sure that -the affidavit is-complete-andprinted Iegibly The,Oepartmerit}�as provided a space afi the botiom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. er.which will be used as a reference number. In addition, an applicant Please be sure to fill in the peimit/license numb that must submitmultiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as pro of 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 1 (i.e. a dog license orpermit 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: Tho CommormoalthofMassaohusotts DepatbOut offridustdal .A,ecldonts Offloo dWestigatiom 600 WashiVou ftx t Boston? MF& 021 Z Z Tel, # 617-72Z-4900 W406 or. 1-877�M MSAM Revised 5-26-05 Fax # 617-727-7749 .�,.- ' r .� , ,' Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 12105 1/21/2014 Apr -June 2014 $250.00 July -Sept 2014 $250.00 Oct -Dec 2014 $250.00 Total Amount $250.00 $750.00 Services Rendered For Merrimack College Electrical Permits Check made payable to the Town of North Andover Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Date..QY .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies ........ has permission to perform..A./ 761 .............. ............... ✓ ............. wiring in the building of. .. ��k ..... at ........ ..... ................................ . North Andover, Mass. F � e. 7,5—A! Lo ........ Lic. No. 10.247,P/W ....... -'*UECMC,kl�- OSPEXFOR Check # r, r r Commonwealth of Massachusetts ' Department of Fire Services \vkj BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �?/� 1/ Permit Fee Assigned tev. 11/991 (leave b] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINTW INK OR TYPE ALL PWORM547I0A9 Date: 1/7/14 Ci or Town of: North Andover, MA City To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution Merrimack College Address 315 Turnpike Street, North Andover, MA 10845 Location and Nature of Proposed Electrical Work: NOTE: C. 143 §31, of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ We will maintain one or more contemporaneous log(s) (check one): This option is available where so contemplated by the municipality. and upon significant changes in employment. NO ❑ YES ❑ NO (� In these cases, you must renew this application annually, The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be ] located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. 41tacl2.S 2pplP.mpntllm sheetQ IfrOnuirad inr 1yili7itinv,n17— 7—f;- Log coverage, and location where it will be maintained ------- %, I --./ -»........w...... w6 wvaso w.w. Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: _ Full-time equivalent electrical employment: 3 How many helpers'or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: �Full-time equivalent electrical employment: a Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate.the number of full-time equivalent staff that number includes: Total electrical employment: cJ Full-time equivalent electrical employment: 0 *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. 1 n� _n>j 10 (Please see reverse side for certifications and required signature.) - The Commonwealth ofMassachuseft D eP .f . artmento bdustrialAccidents Office oflnvestigataons 600 Whshmgton Street Boston, MA 02111 vmmassgov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors)EIectddansfPlumbers Applicant Information Please Print Le Name (snsines /0Wnhztiou dtddual)• 'Merrimack College Address: 315 Turnpike Street ' City/State/Zip: North Andover, MA 01845 phone #: (978) 837-5144 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 6. ❑ New oenshacdon employees (fall and/or pari tune) * have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet: : �• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addiction [No workers' comp. Insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ f am ahomeowner doing all work right of exemption per MGL 11•[] Phimbing repairs or additions myselta [No workers' comp. c. 152, §I(4),and wehave no 12,❑Roofrepairs insurance required.] t employees. [No workers'• 13.[] Other comp. insurance required.] �A applicant that chefs box#t must also fill outthe section below showingtheirwor]�rs' compensation policy information. I Homeowners who submitthis affidavit indicating they Hie doing all work and then hhe outside contractors must submit a new affidavit indicating such. t0ontractors that check this box must attached an additional sheet showingthe name of the sub -contractors and their woft& comp. policy inforundion. lam an employer fliat is provNing workers' compensation karance for my employees Below is ehepolicy aud'j'ob site information. .InsruanceCompany Name: Atlantic Charter 1�:1J,,0 % ,410'1 Policy # or Self -ins. Mo. 4: WC 100078403 ExpirationDate: l / 1 / 14 - 1/1/15 Job Site Address: 315 Turnpike Street- City/staie/Zip: No. Andover, MA 01845 Attach ay. copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as regniredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up�to $1,50 0.00 and/or one-year imprisomneni 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. Ido Hereby certify)fip ftthipairts andye�a ft ofpe&ry Aat the intrmadon provided above is true andcorree4 Official use only. Do riot write in this area, to be completed by city or town official ficial City or Town: Perxnit/S,icense # Issuing Authority (circle ene): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. PIumbingInspector 6. Other - - I K . Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 12105 1/21/2014 Apr -June 2014 132151 $250.00 12212 3/10/2014 July -Sept 2014 132151 $250.00 12212 3/10/2014 Oct -Dec 2014 132151 $250.00 12212 3/10/2014 Total Amount $1,000.00 $0.00 Services Rendered For Merrimack College Electrical Permits Check made payable to the Town of North Andover Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Date ��......!....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... K!.`"`�."�...S;..3e.1.N..!!A--3 has permission for gas installation ....... I` ,0 e-g,,M yr-,.1�. (---- 0 m the buildings of............5............................................................ i ................................... . Norte Fee 17D..'".. Lic. No.�.�.,.�..... q?....' ,s ^..'., Check # ' --52- 161 ::.... ........D���►� Mass. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK * CITY NORTH Andover MA DATE i / 14 /14 PERMIT # j OBSITE ADDRESS 315 Turn ike St. OWNER'S NAME I Merrimack College GOWNER ADDRESS TEO 978) 837-5449 F 978)837-50 5 TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: ® PLANS SUBMITTED: YES D NO© APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER <'tJNVENTED ROOM HEATER WATER HEATER t THER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES []NO 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYF-3OTHER 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 acqurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be In complianceM all Pertinent vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME N e%/''� LICENSE # f/ SIGNATURE MP �MGF 0 JP ® JGF [j LPGI ® CORPORATION ©# PARTNERSHIP ®# LLC ®# COMPANY NAME: G 1114Ct G°",fG%JADDRESS CITY STATE ZIP Ol TEL �S' �3? /_ytz_ - Il FAX y5VG CELL EMAIL f 19d -MA -^1 //"AC 1' L v !T ` The Commonwealth g fMmsachusetts , - Dgwhnent of 1ndusftk1 Accid Y& • • Office of Investiga biff k I 600 Washington Sfteei Boston, V .MA 02111 www.t=sgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectridandPimnbers Applicant Information Please Print Les=ibly Name (Businesslo a hationfin-dividuan: - Merrimack College Address: 315 Turnpike Street City/State/Zip: North Andover, MA 01845 phone#: (978)837-5144 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 eonsiruction employees (full and/orpari time).* have hued the sub -contractors 2. El am a sole proprietor or partner- listed on the attached sheet t 17. ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, []Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself [NoworkeW comp. c.152, §1(4), and we have no 12.Roofrepairs insurance required.] t employees. [No workers'• ME] Other comp. insurance required.] ?Any applicant that chedm box#1 must also fl1 outthe section below show:mgth*workeas' compensation policyiufomIStion. T Homeowners who submitthisaffidavitindicatingtbeyfiedoing allworkandthen him outside contradwmustsubmitRUM affidavitindicatingsuch. frontractors that chec cthN boxmust attached an adddional sheet showingthe name of the sub -contractors andtheft workers' comp. policy infounation. lam an employer that is providing workers' compensation it wance for my employees .Below is thepoticy and foh site information. .Insurance Company Name:. - Atlantic Charter Policy # or Self -ins. Lie.. #: WC 100078403 BxpirationDate: l / 1 / 14 — 111/15 J'obSiteAddress- 315 Turnpike Street • City/Stote/Zip: No. Andover, MA 01845 Attach a. copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A o£MGL o. 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 &o violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DU for insurance coverage verification. X do Hereby cert t/he aims and penalties ofperjury that the information provided above is true and correct - Signature. A,111 Date: / ��•�� Official use only. Do trot write in this area, to he completed by city or town of ficial City or Town: PermWUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - ------ W, vr,--44. to N M I• H Ln rI H N n H O U • H OQ� z F� O Woo xn0 ULn ON N O �i v. CM H O N N \ H �o W O \ U1 (Y) re O -H ..W � 54oa Q rd C�HC7 rdU U o N \ W d' Ho 9\ Q� O Lf1 1 111 1 � I 00 1 0 I I Q I H 1 O 1 Ln 1 (N 1 . 1 N 1 tf)7 I LP1 rm O Mi cc Ln 1 cc Ir C.0 1 O O O O ru ru O r•� Ln a ti rm a O F• 1 O Y Y i; "f • YF Y O ~OW k + N 1 LP1 rm O Mi cc Ln 1 cc Ir C.0 1 O O O O ru ru O r•� Ln a ti rm a Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 9076 1/212014 Apr -June 2014 132151 $250.00 9136 3/20/2014 July -Sept 2014 132151 $250.00 9136 3/20/2014 Oct -Dec 2014 132151 $250.00 9136 3/20/2014 Total Amount $1,000.00 $0.00 Services Rendered for Merrimack College Gas Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover 11 F) 4- CEJ This certifies that ...��.:...J Ile � 41 has permission to perfonn..**/�-/"*`­*-e**�-,pe,e ��.�n.,..�.'*'-*b*ee-.,2()/� plumbing in the buildings of ............. .P/? ........ le PC.. .............. ............................................. Xf-A� -N;rtWA over, Mass. .......................... 75v . ..... Fee ................. Lic. No. �Y? .... .... ?.�. ...... ...... . ... .... ..................... .......................... LU IVIBING INSPECTOR. Check #/-30?/6-/ . Date,3.fiJ"f ........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE � ] PERMIT # 0 l - JOBSITE ADDRESS 315 Turn'1ke Street OWNER'S NAME Merrimack College POWNER ADDRESS TEL (97g) 837-5449 FAX 8 837-5])6 TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ® RESIDENTIAL Ll PRINT CLEARLY NEW: RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES © N00 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 GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYS EM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK N OILET-- QRINAL 14NASHING MACHINE CONNECTION 'NATER HEATER ALL TYPES _ WATER PIPING OTHER _ INSURANCE COVERAGE: 1 have a current liabilily nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES F-�j NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Eg OTHER TYPE OF INDEMNITY Q BOND El 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 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 compiia th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEi[� s%bpijAe —LICENSE # r, SIGNATURE mpg, JP 0 CORPORATION FI#PARTNERSHIP®#LLC9 j COMPANY NAME .�L71/P�� AGZ G 6L b L=6� ADDRESS sl— CITY CITY j STATE i ZIP 01 f �/ S—� TEL I `3 7Vi f FAX CELLEMAIL .S'/ /,1L%n-v� COMMONWEALTH OF MASSACHUSMS DIVIS • :.... . PLOWIERS , 4D GASFIT° #&tt: LICENSED AS i MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: RANDY L SIDEMAO 1431 PAWTUCK.ET i'►.VD / UNIT 9 ✓/ LOWEL,L Ml 01854-107 10149 05/01/11- -164557LICENSE NO. EXPIRATION DATE SERIAL NO. COMMONWEALTH OF MASSACHUSETTS • 1ND -. • PL:ES A (W •. GASFIT ffg LIC►`►�SED AS A JOURNEYMAN 'PLUMBER. ISSUES THE ABOVE LICENSE -10: RANDY I_ SIDEMAN 1431 P%WTUCKET BLVD UNIT 9 LOWELL MA 01854-1073 19774 (t�-/01/14 164556 , LICENSE • EXPIRATION DATE SERIAL NO. j - Ae Commonwealth ofMassachusetts , - Depiii m ntofDtdusf*IAccidents • Office ofbwevstdgadons 600 Washington Sheet Boston, MA 02111 www.rna sgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele4 thidanslPlmnbera AmUcant Information Please Print Les=ibly Name (Business 0rganu`za.tion/tndividnd)' ' Merrimack College Address: 315 Turnpike Street City/State/Zip: North Andover, MA 01845 phone#: (978)837-5144 Are you an employer? Check the appropriate box: Type of project (required: 1. ❑ I am a .� Y e to erwith 4. ❑ I am a general contractor and ` 6. ❑ New construction employees (full and/orpari time). 2111 am a sole proprietor or partner- have Mod the sub -contractors listed on the attached sheet f �• ❑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 1011 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing allwork officers have exercised their right of exemptionperMGL 11. F1 Pl mbingrepairs or additions myself [No workers' comp. c. 152, §1(d,and wehave no 12.❑Roofrepairs insurance required.] t employees. [No workers'• 13.0 Other comp. insurance required.] !Any applic;antthat chedm box#1 must also fll outthe sectionbelbw showingtheirworime compensationpolicyidormation. T Homeowners who submit this affidavit indiostiagthey dh doing allwork and then hire outside contractors must submit anew affidavit indicating suek tGontradors that check M boxmust attached an additional sheet showingthe name ofthe sub -contractors and their workers' comp. policy fi&mldon. lam an employer that is providing workers' compensation insurance for my epnployees:.delow is the policy andjob site infomadoiL .Insumce Company Name% - Atlantic Charter Policy # or Self -ins. Lie. #: WC 100078403 Expiration Date: l /1/ 14 - 1/1/15 Job Site Address • 315 Turnpike Street. CitylSfaie/Zip: No. Andover, MA 01845 Attach a. copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,50 0.00 and/or ones -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 $.e violator. Be advised that a copy ofibis statement may be forwardedto the Office of Investigations of the DIA for insurance coverage verification. ' Ido hereby cenfffy zM the airs and penalties ofperjury that the information provided above/fs true andeoprat - Si e: Date:��- Phone#: Official use only. Do not write in this area, to be con pleted by city or town q ffrcitcl City or Town: permitlucense ff Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown CIerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - Irv--A--J.'n---- 'Dh-- ". r v.4 Ln N M • Ln N M r-1 0 0Qvi- z x o W H O x90 U lIl N N U) 0 III H O N N \ H �o W O F-1 O H W U 90 Q a UH0 W di x H U O N \ W di [-� O Q� 0 Ln Ln w 00 OD Q H �-I O rd 9 �-I 0 z 44 �O i -i 3 O H ;t 9i [ 1• F FII I F F +t 2 i I••I•hI LIQ F y-' IP1, VIM rl• • r Fi�FI rr•� E . 1`t� 1:( Y a o w 44 "��. � ��� L�iJ 'i � t si � -: ^r * i I I I•I•�Yt V H. 4 ,4i ,w k�, CN H v Z'0 0 J L ro 1 111 w. �+ 4 4J s� tv- z 1447 .q. v # z U}z 1 �Al� 1r Y 1 ril O ru ca Ln J 03 Ir LD 1 O O O ru ru O a Ul .a ru rm �k }�A - •x O } Q >z ` ;t 9i [ 1• F FII I F F +t 2 i I••I•hI LIQ F y-' IP1, VIM rl• • r Fi�FI rr•� E . 1`t� 1:( Y a o w 44 "��. � ��� L�iJ 'i � t si � -: ^r * i I I I•I•�Yt V H. 4 ,4i ,w k�, CN H v Z'0 0 J L ro 1 111 w. �+ 4 4J s� tv- z 1447 .q. v # z U}z 1 �Al� 1r Y 1 ril O ru ca Ln J 03 Ir LD 1 O O O ru ru O a Ul .a ru rm Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 10362 1/21/2014 Apr -June 2014 132151 $250.00 10420 3/10/2014 July -Sept 2014 132151 $250.00 10420 3/10/2014 Oct -Dec 2014 132151 $250.00 10420 3/10/2014 Total Amount $1,000.00 $0.00 Services Rendered for Merrimack College Plumbing Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover r) Date ... !.1.74H ............ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that..K....".." -a -,-0 W\C, j .... ................ .... ........ ................................................... �� ��lD., * ........ -*14 216 has permission to perform.... . ... ... .... Lel ....... p{'.lz.v."A..... .......... . ............. plumbing in the buildings of IL- .................................................................... at....?5.A.5 ....... -TA-e-P...\.....A-........ ...........Norh Andover, Mass. Feet,= Lic. No. 1041 .... ...MA............................................................. :Y PLUMBING INSPECTOR Check# Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 10362 1/21/2014 Apr -June 2014 $250.00 July -Sept 2014 $250.00 Oct -Dec 2014 $250.00 Total Amount $250.00 $750.00 Services Rendered for Merrimack College Plumbing Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover ANWIt-p, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE [jL �_ ( PERMIT # Mo" JOBSITE ADDRESS 315 Turn' ike Street OWNER'S NAME Merrimack College POWNER ADDRESS TEL4_ IFAX 5K837751 TYPE OR OCCUPANCY TYPE COMMERCIAL Df EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES 0 NOD FIXTURES Z FLOOR- BSM 2._ 3 4.. 6 7 8.._.__ 9 1_ 1_....___1._ 13 BATHTUB _1 CROSS CONNECTION DEVICE __. DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OlUSAND SYSTEM —_0 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ._..__5 ..._._1.2 _1_4 DEDICATED WATER RECYCLE SYS EM ___fIIif DISHWASHER ffff(f DRINKING FOUNTAIN _f ._.._. i ._ (......`:. FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY f ____� .____-� - _ I ____-! --___. f __._...I 1 I ._.__.-.-_ ROOF DRAIN SHOWER STALL __._! __ _j SERVICE/MOP SINK f J ! f __- 1 f _ _._I .__._.� I ___I TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATERPIPING OTHER f f , a INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO f IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY © BOND Mf 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 Q AGENT El 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 complia ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the—General Laws. PLUMBER'S NAME i r / S'IP,—Q IILICENSE # SIGNATURE IMP JP © CORPORATION R#PARTNERSHIP _I # LLC COMPANY NAME /K L�R�'`''� G/� a � � � GL � ADDRESS —C CITY ,�I-io Dk _._ =STATE ZIP!� 1 !ci `�� TEL FAX CELL Vi� _?0% ._... EMAIL _Sl %�L%�wpW 'E. -- --I tiA. C A_ r \V 65 m H °z 0 F U W a w o o Z a O W p w O W a a* Z U = w a a O W CLU 0LU rzx w L d O o a w a � U J CL a a � w x w f- u. H °z 0 H U w P-4 z z as a a Cx7 O �4 The Commonwealth oflilassachusetts - Department of industrircl Accidents Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Legiibly Name (Business/Organization/IndMdual): Merrimack College Address: 315 Turnpike Street Cit=y/State/Zip: North Andover, MA 01845 phone#: (978)837-5144 Are you an employer? Check the appropriate bog: Type of project (required): ti V rt employees (full and/orpart-time).* 2. ❑ I am a sole proprietor or partner- The Commonwealth oflilassachusetts - Department of industrircl Accidents Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Legiibly Name (Business/Organization/IndMdual): Merrimack College Address: 315 Turnpike Street Cit=y/State/Zip: North Andover, MA 01845 phone#: (978)837-5144 Are you an employer? Check the appropriate bog: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I h. ❑ New c6nstruction employees (full and/orpart-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. x 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 area corporation and its 10.I] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. ❑ Roof repairs insurance required) t employees. [No workers'. 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 a're doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. .Insurance Company Name:. Atlantic Charter - Policy # or Self -ins. Lic. M WC 10007 8403 ExpirationDate: l / 1 / 14 1/1/15 rob Site Address: 315 Turnpike Street. City/State/Zip: No. Andover, MA 01845 Attach a. copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requnredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ire up to $1,500.00 and/or oneyear 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 cettlo under the pains andpenaldes of perjury that the information provided above is true and correct. Signature: Date: Phone 4: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License ff. Issuing Authority (circle one): Z. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - TL_--- U. Information and Instructio- 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 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 contractfor the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired 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-ba sure that -the affidavit-is-complete-andprinted legibly: The Departrient as 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. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license o 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. Tho COMMORMalth. of'Musarhusotts Deparbent offaduMal .A,ocidonts office dwestigatkom 600 Washiagtou Woe t Boston? MA, 021.1.1. Tel, # 61.7-727,4900 ext 406 or 1-877�1�SAFB Revised 5-26-05 B# 617-727-7749 COMMONWEALTH OF MASSACHUSETTS PLUMBERS ,�'dD GASFIMRS LICENSED AS 1 MASTED: PLUMBER ISSUES THE ABOVE LICENSE TO: RANDY L SIDEMAil r 1431 PAWTUCKET i'i.VD f UNIT 9 LOWEL,L M< 01854-107 3 10149 05/01/1F 164557 LICENSE NO. EXPIRATION DATE SERIAL NO. COMMONWEALTH OF MASSACHUSETTS DIVISIONPROFESSIONAL UM:BERS AND GASFITTI ITS LICENSED AS A JOURNEYMAN PLUMBER ISSUES THE ABOVE L;CENSE TO: �: RANDY I_ SIDEMAN 1431 PIWTUCKET BLVD i5l UNIT 9 LOWELL MA 01854-1073 19774 P. 01/14 164556 • EXPIRATION DATE SERIAL NO. ti :i Date .... 1. ...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that R".- -P— V\A & has permission for gas installation **I.�l-\./�--,�''*'CP*,?*",'V'**"C')*'�"**"2-0k%� ............ V ......................................... in the buildings of .... 0-% yy\("J,, � t, ................ ................ ...... . .............................. U North Andover, Mass. Fee��.—.... Lic. No.16114.�...... P.J!�� ................... I .............................. GASINSPECTOR Check # 0407 Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2014 129843 $250.00 9076 1/212014 Apr -June 2014 $250.00 July -Sept 2014 $250.00 Oct -Dec 2014 $250.00 Total Amount $250.00 $750.00 Services Rendered for Merrimack College Gas Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover J LN - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' CITY NORTH Andover MA DATE PERMIT # JOBSITE ADDRESS 1,215 Turn ike St. OWNER'S NAME Merrimack College GOWNER ADDRESS TE _978) 837^5449 F 978 837-50 TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL® RESIDENTIAL PRINT CLEARLY NEW: E] RENOVATION: El REPLACEMENT: © PLANS SUBMITTED: YES 0 NO E3 APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS =--I MAKEUP AIR UNIT OVEN _ ( L. J I__ POOL HEATER _J ! ROOM / SPACE HEATER ROOF TOP UNIT TEST - UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [] OTHER TYPE INDEMNITY ® BOND F 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 El 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 ac urate 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 all Pertinenn of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME LICENSE # P/l y j SIGNATURE MP MGF Ej1 JP D JGF 0 LPGI CORPORATION I # ��. - I- I PARTNERSHIP ©#= LLC [:]# COMPANY NAME: _-_G _ lrV4�� Go�.rti GLJ �� ADDRESS CITY /� �/STATE ZIP OJ TEL FAX G _ CELL 1.01 EMAIL — -- - ��, 2�MAc L,� - --- V ` \Vv 0 H O z 0 H U W a w y, o ❑ z O N� W r a Z U w �* a w 5 a O LU � w w W U W o a a a � U x J F., 0- D) D w zw f- L W H z° 0 H U W a C7 x . o x m - The Commonwealth ofMassachusetts Department of lndustrIglAccidents D, face of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensations Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Merrimack College 315 Turnpike Street City/State/Zip: North Andover, MA 01845 Phone#:, (978)837-5144 Are you an employer? Check the appropriate boa: Type of project (required): 1. ❑ I am a employer with 4. ❑ T am a general contractor and I 6. [] New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. x 7• ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We area corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10.[] Electrical repairs or additions 3. ❑ T am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑Roof repairs insurance required.] t employees. [No workers! 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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. h=ance Company Name:. Atlantic Charter Policy # or Self -ins. Lic. M WC 100078403 ExpirationDate: l / 1 / 14 1/1/15 Job Site Address: 315 Turnpike Street. City/State/Zip: No. Andover, MA 01845 Attach a. copy of the workers' compensation- policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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 ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwardedto the Office of Investigations of the DTA for insurance coverage verification. X do Hereby certify u r the airs andpenalties ofperjury that the information provided above is true and correct: - Signafore: Date: ��• Phone 4: 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): X. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. PIumbinglnspector 6. Other - Information and Instructio- 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 him, 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 o members or partners, are not required to cather Than the carry workers' compensation insurance. Tf an LLC or LLP does have employees, apolicyisrequired. 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 requiredto 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-andprinted Iegibly: The,Oepart►riPritlias provide�c 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 pemlithicense 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. Anew affidavit must be filled out each Year. Where a homeowner 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 NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Gox�nx�oz�wca�tl�of�assachusetts Depaz`ixxteztt offAdwtdal .Accidents OfAce of Up 690 Wasbingtau Streat Boston, MA, 02111 Tel. # 617-7274900 o#406 ox 1-877,MASSAk`.� Revised 5-26-05 Ba 4 617-727-7749 - x . ~o___- WEALTH OF MASSACHUSETTS \ {� �1i PLUMBERS, -pPr RS LUMBER ISSUES THE xaovsLICENSE TO: RANDY L SIDEMA.l PAWTUCKET i`iVD UNIT 9 LOWELL M� 01854-10/ 05/01/1't 164557 — � - -� DIVISION OF PROFESSIONAL Ll . CENSURE - BOARD OPI, wwSF L|CC�T3Eb AS AJOURNEYMAN PLUK8BER ISSUES THsABOVE uKswSsTO: RANDY L SIDEMAN 1431 P%;4TUCKET BLVD / UNIT 9 V LOWELL MA 0l854- � 19774 0�/01/14 I64556 �` < @This certifies that ..... N �.r`!`!��cr .. .,....... ... . has permission to perform. .�..^ . �.�??'..� . ! ! !� ` . QPM iyO-f wiring in the building of . Oe'Op1r,i) L.. . �! .......... at . --i p, �.Q.-. .............. , North Andover, Mass. Fee .? }*L2. . Lic. No. /V/ 7ZA b . � . P.. H �P. .... ? ELECTRICAL INSPECTO� Check # 11 h � 24 1 Ilk t MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 15 -Nov -12 PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas / Plumbing / Electrical WHAT: $250/each TOTAL PAYMEh $750.00 Account No. 10-6010-6223 --------------------- -------------------- APPROVALS: DISTRIBUTION Amount $750.00 ------------------------------------------ ------------------------------------------ -------------------------------------------- a Ln M O a� L['1 O ON o .z Os>.::;° H Ln E I v O 1 • � I I Ln I O E-1 Ln I rn OQ W ko I z OD I Ib 1 L O 1 Q i O W Z LL o HI I Ln I M 1 Ln E -r O I 01 O 1 ri 1 r� Q O I U Ln I d. • H � I OQV 1 z I O N x O 1 U O WH 1 xO O.Ntn u Ln I, O 1. Y li I� li Q � I O II �ZJ)7 O >; I N rl 1 s O 1 N W 1 \ I 01 M H H \ 0 1 H N H 1 �4 I � I U > 1 W 0 E-+ H X I O 1 I Q fli UHC] �-4 I I x H Z I U o N 4--I I \ 01 W Ln H I Q I H h 4n a� t . �- .z Os>.::;° E w i v -x a, 0 O rn OQ O Ln 0 is J ❑ i L CO.: , O W Z LL .yc k 124 In . Z .Q d. U. Z O N n O.Ntn Z \ dl r i Y rl r� Q O >; U � U .r a� t . �- .z E w i v r a, E. CO N .a Ln ti E%. -- Ln Ln t. O Ir M a O rm .a a O Ln M Ln Q' a ■ t . �- .z 1 w i v 0 i L z �>I 124 E. CO N .a Ln ti E%. -- Ln Ln t. O Ir M a O rm .a a O Ln M Ln Q' a ■ 0 MERRIMACK COILLEGE PA ZMEN T VOUCHED DATE: 13 -Dec -12 PAY TO': Town of North Andover j 1600 5s—good Street North Andover, MA 01845 a. CHECK STUB Qu"arterlv P, -r -if Date Z`' �� - --------- - JOWN OF NORTH ANDOVER PERMIT FOR WIRING ---------- 77 67 This certifies that ............ 2-6 has permission to perform . ....... ...... X wiring in the build .... at ..... 9,? M Nort Andover, ass. Fee Lie. No. 124�24M& ......... P FrTR CAL INSPECTOR Check # izPASAP 11326 -------------------- ------------- - - - --- - - --- - - APPROVALS: 0.00 ---------------------- ---------------------------- ------------------------------------------ --------------- ------------- � � MERRIMACK COLLEGE EA YMENT —VOUCH PAY TO: Town ufNorth Andover T6-00 Osgood �Street North Andover, MA 01845 CHECK STUB.Quarterly Permit INFORMATION: January to March FOR Gas, Plumbiing, —Electrical WHAT: TOTAL PAYMEN Account No. 10-8010'8223 ' —`---`----------~-------- _______________________ ____________________ APPR0 VALS:'zl�^�� DATE: 13 -Dec -12 DISTRIBUTION Amount ---------- --------------------------- ------------------------------------------- ------------------------------------------ - ------------ ----------------------------- FSI MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: =Town of North Andover 1600 Osgood Street North Andover, MA 01845 Date. M TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. ...... ............. has permission to perform . � .�..�.2-01.->:`... f es+ P�'(-r&'. wiring in the building of . !? �,^�> Ll... .r3� ?-........ . at . CSP.iItc— .......... . , North Andover, Mas Fee Lp .. Lie. No. 76,x. . . �`'�U (..V ELECTRICAL INSPECTO1 Check # M 6 1 r 11241 DATE: 15 -Nov -12 DaZoo` I te.......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that e,Vle� has permission to perform RA" " wiring in the building of..!....1P.....R...`r`G �� , at. 3.t 5..uir.� Q-- .......................................... . North Andover, Mass. Fee ��............... Lic. No.��..... .. 4 . ........... /tl ......... . r � , \_� � LECTRICAL INSPECTOR ` Check # 121(0�l 1 '7 Commonwealth of Massachusetts Official Use Only �• M , Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned LOD — ' a [Rev. 11/991 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: January 10, 2013 City or Town of: North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution . Merrimack College Address 315 Turnpike Street, North Andover, MA 01845 Location and Nature of Proposed Electrical Work: NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES ❑ NO V This option is available where so contemplated by the municipality. In these cases, you must renew this application annually, and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: V Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) Institutional Permit Form, page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. My title is:ent� t My authority to act for the aforementioned institution is: I certify, under the pains and penalties of -perjury, that the information on this application is true and complete. Si nature Dated (Print name) G; 1 PP -44 ' t -11 -- (work telephone number) r7��---,' f ~- 11xtension) (facsimile number) �V'1iYF1 I : LEO'R I C i k NORTy OF ASO � OL ' �� m SSACHUS� Date .I. � �P ) � TOWN OF NORTH ANDOVER PERMIT FOR WIRING t This certifies that .. F!W-77-Ar/.5..... 445 L- � �-- .. . has permis i wiring in the building of ..►-.!' P.� � St at ......... �..... � .k.l . .t� �, � .�.....'..... , North �Andover, Mass. Fee . ' Lic. No..�.Z.4 7, !!'! v ELECTRICAL INSPECTOR Ceeck #lel �l 325 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION. REGULATIONS Official Use Only Permit No. 1132-6 Permit Fee Assigned 11/99] 4 a,eA-/-''`APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (2. d1 - l Z• City or Town of: North Andover, MA To the Inspector of Wires: ray this application the undersigned gives notice of the on -premises performance of electrical work by employees. stituti, A-,. dress Date .1.2. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.., f has permission to perform ..flU�.l 13 ���, A wiring in the building of .... �,/� �(¢ f.� . at ..... -�.,.5.. i trtfr� �. �... ........ . .... , North Andover, Mass. Fee .( �--Lic. No. `.1:x.1? 7%-....... ELECTRI AL INSPECTOR check # l Z 0 3� l 1 11326' / c. .ectrical installations to give notice of each such occasion, or if so contem- contemporaneous log of such work, ut advance notice. Some municipali- )ove a stated magnitude. must renew this application annually, fined. You agree that the log(s) will be property except by arrangement with additional loz locations. a ;4. If you intend to apply for such _ prroce- How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under1heir direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: - Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) WFIAPOCIPIWEALTO OF MASSACHUSETT ELECTRICIANS AS A REG JOURNEYMAN ELECTRIC[.,. ISSUES THE ABOVE LICENSE TO: - JOHN R DEMATTEIS 8 WILSON LN F OR D 'WE MA 01886-17 28794E 07/31/13 '8224 U11, Fold, Then Detach Along All Perforations COMMUNWEALNt-11 OFMiASSACHUSIETTS,_ -ELECTRICIANS REGISTERED MASTER ELECTRICIAN. ISSUES THE ABOVE LICENSE TO: —2) .DEMATTEIS ELECTRIC JOHN.A DEMATTEIS .0 WILSON -LN WESTFORD MA 01886-1 _ 24760 /13 8 2 2420 Fold, Ths-ri Detach Ale -rig All Per fore.' onions Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. L BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned [Rev. 11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: January 10, 2013 City or Town of: North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution Merrimack College Address 315 Turnpike Street, North Andover, MA 01845 Location and Nature of Proposed Electrical Work: NOTE: C. 143 §31, of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ We will maintain one or more contemporaneous log(s) (check one): This option is available where so contemplated by the municipality and upon significant changes in employment. NO ❑ YES ❑ NO In these cases, you must renew this application annually, The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: ' How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: 0 Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: n Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) Institutional Permit Form, page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. My title is: © .TO iovh L g�L My authority to act for the aforementioned institution is: I certify, under thepains and penalties ofperjury, that the information on this application is true and complete. (Signature) (Dated) (Print name) CA (work telephone number) JW-0?4_11(�extension) (facsimile number Official Use Only Commonwealth of Massachusetts Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned [Rev. 11/99] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: January 10, 2012 City or Town of: North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution Merrimack College Address 315 Turnpike Street, North Andover, MA 01845 Location and Nature of Proposed Electrical Work: NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES ❑ NO This option is available where so contemplated by the municipality. In these cases, you must renew this application annually, and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: �_5 Full-time equivalent electrical employment: 13 How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 1.56). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: 0 Full-time equivalent electrical employment: Not'all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) '+Institutional Permit Form, page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. My title is: P «0 P_ S ys (,/2 �-�W� � My authority to act for the aforementioned institution is: I certify, under the pains and penalties of perjury, that the information on this application is true and complete. (Signature) (Dated) (Print name) r,1D 6gjQ:7" (fZPMA (work telephone number) T�Z 93 % --__/ &tension) (facsimile number I— -- --1 �yS MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: =Town of North Andover .1600 Osgood Street North Andover, MA 01845 Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. 2—D — has permission to perform . . . ......175.......... ........... wiring in the building of . 0--e- P P-If'v) .01dL. . 0.4 ........... "I — ............... North Andover, Mass. Fee Lic. No. 12-q 70. M b.-fy:Lr. P'. K -A (.,Pv ELECTRICAL INSPECTOR .Check # A 11241 DATE: 15 -Nov -12 ----------- ; ---------- • �}EumQ Ja. �.I�M �h i�pe9- .lu,,, za3 t�iLJ Iz�vr V40 R Tuf ►�271�iz� °I�O�j Y f Date v. TOWN OF NORTH ANDOVER i PERMIT FOR WIRING This certifies that ......... =+A1. 0 Y has permission to perform .%-I 77r.7-7 .... cu r wiring in the building of . 0 41 ........... at1. ••North Andover, Mass. Fee '7Lic. No ... ...... . ELECTRICAL INSPECTOR • Check # o 32 M 30 Z 00 G) Z 0 X -1 z x 0 7 3 2 Date -1 z � r r 0 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING M X Z This certifies that ......... 24f. i2d,, "YL'J.P .............. has permission to perform .2S plumbing in the buildings of -00"to ....... at...... I . . t (,-).( .... , North Andover, Mass. FeeLie. No.......... .................. ... PLUMBING INSPECTOR Check # PP r z > 0 z > 0 . W- 0 LL. 0 cy cc'I' to (1) LO C;j m 0 0) ri H O H 0 OQ-ul x O u o U Ln O N H O N -1-3 \ • r -f O H �4 \ a) N Pa H I-ci r W U rd 40 Q U H h W N x � u O N rn\ Q N �:•G6•Gfi•6„ 0 0 o Q O Ln t•-� is O w �c w C0 0 C'3 �y. } z z Z Q a 44 J O i- 0. co 0 m a'` �G o H Q\o': 'CO)'CO N Pa m � N �:•G6•Gfi•6„ ■ cc It ,a LIt ti I\-- Ln tLn Ir rm a rm a lD Er rm ru { :a i � w 0 C'3 �y. z z 44 J co a'` �G o H Pa ■ cc It ,a LIt ti I\-- Ln tLn Ir rm a rm a lD Er rm ru { :a i � MERRIMACK COLLEGE EA YMENLY—OUCHER PAY TO: Town of North Andover 1600 Osgood North Andover, MA 01845 I DATE: 13 -Dec -12 CHECK STUB QuarterIv Ptzrmif Date JZ` �7! 4 WR TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 21� has permission to perform .... . . . . . . .......... wiring in the build �6— I at ..... Nort Andover, Mass. Fee �b.-7 Lie. No. ......... A. 0) 7 ELECTR CAL INSPECTOR Check 4 ) 2-0 3� 11326 �!0.00------_-__ f--------------- 0-------- ---------------- ------------ ------------------ --------------- ------------------------------------------ -------------------------- APPROVALS:, C n ° D O �- w � rIn '+J f zF-'H O o" O H O PI O f.. �O 1 Lh O V) !•h (Y0 V a. o z O O O C an n � m rt .. Ao0 rt O 00 Ln Ln ul C7 Ct 1 u9 M ;a rim tii 9 Qrnt7�h, C) rn _ ppiJ<ti) hJ A C? rn W In W;o>RJ O n l I al t-1 ry N r • CO.O I Q GJ Q ti% CN+ m ` NJ nyy� U'! .y • • 11 �' �y N R7 —' �a O co � A EG F r ru O W mX u - O it, it, W O r w .13 - O LriO ru Ln r 133 INS I H i d m 00 0,11 cn to 40 w� N N o tx=J C4 H P4 P) Ho Ell n t3J (11 t .. F-1 ro. N K F1 00 Ct N O N N O In m o x • H trJ o n O x z 4A d ° H • 01- m NN 0 HW 0) 0 O -mz tij b�H O ui H 0 O 0 0 �U D; 17-4 -h „ r O H m h LTI G7 Fj ., tTj ::C.-� z 0 i N 1 J 1} I �d�N •I�•1) r INS I H i d m 00 0,11 cn to 40 w� N N o tx=J C4 H P4 P) Ho Ell n t3J (11 t .. F-1 ro. N K F1 00 Ct N O N N O In m o x • H trJ o n O x z 4A d ° H • 01- m NN 0 HW 0) 0 O -mz tij b�H O ui H 0 O 0 N 00 N D; „ r ,k o ::C.-� z �� 1 J 1} I �d�N •I�•1) r II Ii; Id) I�1 S 1 �F cn 31 LI. '� w oda aal.� K IM w �o Ln o, < 0 0 rn 9511' 1%•j • SIlSII ?.1� 0 tP INS I H i d m 00 0,11 cn to 40 w� N N o tx=J C4 H P4 P) Ho Ell n t3J (11 t .. F-1 ro. N K F1 00 Ct N O N N O In m o x • H trJ o n O x z 4A d ° H • 01- m NN 0 HW 0) 0 O -mz tij b�H O ui H 0 O 0 Commonwealth of Massachusetts —-—Department of Fire Services BOARD OF FIRE PREVENTION, REGULATIONS Official Use Only Permit No. 1 63 -LZ Permit Fee Assigned [Rev. 11/991 (leave blank Ov,��J� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 'alFOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEA SE PRINT IN INK ORTYPEALLINFORMATION) Date: October 31',:2011 City or Town of.. North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Instituti Address r'^ ►0552 tORTN F ° O� P • - - --- ---.1 T, l -,.a...,.,,1 117,.•.1'. alb �.t.`O.7.15 ..... j/. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.......ili(✓l2wi , ..................... ........... has permission to performyE?L,,��"' ................ ...... ............ wiring in the building of /rl � ��f2- LGL G / 7' g / .........................................-.... at ..... ter- ...... Uf., ."........s� rth Andover, Mass. Fee . �0. Lic. No...... #:. iLECC' ICAL INSPECTOR V Check # -7 t-1,19% electrical installations to give notice of n each such occasion, or if so contem- a contemporaneous log of such work, lout advance notice. Some municipali- above a stated map-nitude. must renew this application annually, ned. You agree that the log(s) will be property except by arrangement with additional log locations. If you intend to apply for such - proce- How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: '3 Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that member includes: Total electrical employment: Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required - . :.CO(t MCNWEAL` H OF IIilASSACHUSETT .ELECTRICIANS AS A REG JOURNEYMAN_ELECTRICI, ISSUES THE ABOVE UPENSE l0: JOHN .R DEMATTEIS 81 WILSON LN`�. 'WESTFO:RD MA 01886-17 1 28794 E- 07/31/13 82242` WT- ® s Fold, Then Detach Along All Rerioreiions CONAMUNWEAL. (i i OF ifkTiASSAChUSETTS, d Foid, Thsn Detach ;along All Fe;firr i;_ ns A 57- /I f -r i %COMMONWEALTH OF MASSACHUSETT ELECTRICIANS AS A REG JOURNEYMAN ELECTRICI TO. ISSUES THE ABOVE LICENSE_ JOHN R DEMATTEIS 8 WILSON LN WESTFORD MA 01886-17 28704 E 07/31/13 8224 Fold, Then, Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS', ELECTRICIANS REGISTERED MASTER ELECTRICIAN. ISSUES THE ABOVE LICENSE TO: .DEMATTEIS ELECTRIC JOHWR DEMATTEIS .8 WILSON LN WESTFORD MA 01886-1 t6*, - 1 2V6 A_-, 07/31/13 822420 Fold, Thsto Detach Along All Pei iorejmms Date.....1.k�y? ..% TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ......... ?...... �`�!: a -!(`n ✓ ........................................ � n has permission for gas installation .1 �r' •` . ?.. ?. ; r-.. ,,�i. -if e— in the buildings of ..P....R..,::.�M!4r L� n.;:1�Q.,.1 at , L ... ' ,. r :1.4 .. '........... North Andover, Mass. Fee;3 ��..n... Lic. No...�..�'- °�.......!,0.......................................................... GAS INSPECMR Check # 12 nr)*v• t,u✓J Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2013 119535 $250.00 8457 11/21/2012 Apr -June 2013 120396 $250.00 8519 12/26/2012 July -Sept 2013 127696 $250.00 8896 9/30/2013 Oct -Dec 2013 127696 $250.00 8896 9/30/2013 Total Amount $1,000.00 $0.00 Services Rendered for Merrimack College Gas Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2013 119535 $250.00 8457 11/21/2012 Apr -June 2013 120396 $250.00 8519 1 12/26/2012 July -Sept 2013 $250.00 Oct -Dec 2013 $250.00 Total Amount $500.00 $500.00 Services Kenaerea for merrimacK couege Gas Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover -lw%IEu)PPl -R This certifies that .....� "` (s, J-0— 'G. ^� _ .... ........ ... has permission to perform .. .. } �....... plumbing in the-buildings of ... �.`. ....`' ..... ��'I P ....... at . ..1� UK `J.T . .... . , North Andover, Mass. Fee 'ono ... Lic. No. % N `C ' !�? .................. ... PLUMBING INSPECTOR Check 4 121(o�y Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2013 119535 $250.00 9676 11/21/2012 Apr -June 2013 120396 $250.00 9732 12/26/2012 July -Sept 2013 127696 $250.00 10186 9/30/2013 Oct -Dec 2013 127696 $250.00 10186 9/30/2013 Total Amount $1,000.00 $0.00 Services Rendered for Merrimack College Plumbing Permits Please send tol600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover Town of North Andover Quarter Check No# Amount Pd. Permit No# Amount Due Dt. Rec'd Jan -Mar 2013 119535 $250.00 9676 11/21/2012 Apr -June 2013 120396 $250.00 9732 12/26/2012 July -Sept 2013 $250.00 Oct -Dec 2013 $250.00 Total Amount $500.00 $500.00 Services Rendered for Merrimack College Plumbing Permits Please send to 1600 Osgood Street, Building 20, Suite 2035, North Andover. MA 01845 Check made payable to the Town of North Andover 1ViASSACFiUS€TTS URIIP6RM APPLICATION :FOR A PI`RMIT TO PERPO}2)111 P1_UM.15ING WORK CJTY CI MA DATE,>`� PERMIT #' ... K �. JOBSITE:ADDRESS OWNERS NAME',G IOWNER ADDRESS. is TEL FAX:. Ijr t - .. w TYPI=.OPS OCCUPANCY TYPE COMMERCIAL EDUCATIONAL, � RESIDENTIALIC] PRINT CLEARLY NEW; t RENOVATION: 21 REPLACEMENT; , PLANS SUBMITTED; YES01 ` NO01 I FIXTURES 7 FLOOR asM i 2: 3 4 5 1 6 7_ ;< $ � 1Q I�. Ti7 13 1 34 DEDICATED; GREASE SYSTEM DED1CATES GRAy'wATER::SYSTE(ul: DEDICATED:VVATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER. FLOOR !.AREA DRAIN INTERCEPTOR iINTERIQR.) . KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES . . 'III IF dit tit : 3i ...... tlt =11 : lit � no t WSW APVa GDVEEtAGE: _. i t have a current liabliit ' insurahce policy of its substantial equivalent whtcb meets the requirements of i11I,G1. Ch.142. YES [,j NO f YOU CHECKED YES,PLEASE INDICATE THE TYPE OF.COVE RAGE BY CHECKING THE APPROPRIATE BOX BE, LOW LIABILITY INSURANCE POLICY OT14ER TYPE OF INDEMNITY BOND OWNER`S1NSURANC:E WAIVER. lam aware that the licensee does not have the insurance coverage required by Chapter 942 of the. _Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONEONLY: OWNER 0 AGENT LJ SIGNATURE OF OWNER OR AGENT I hereby certify,that all of the details and:informatton I havesubmitted or entered regarding_ this.application are true and accurate to the best ofiiny lmowledge and that all plumbing wo(k and lrasfallations .performed under the permit issued for this appiicatipn will be:lp compco with a t Pertl nt provision ofthe Massachusetts State :Plumbing Code and Chapter 142 of tie General; Laws. PLUMBER'S NAMESAW LICENSE#.Q% SI NATURE •,VIP .. JP _ CORPORATION # �F'ARTNERSHIP'LLCL .... z++.�3�awgse mS`.«i ' OOMPANY NAME: OITYt . A�"�i0, STATE/Ll`.ZIP TEL FAX REQ S'1+ CELL � S�J�EMAIL �����'�C!�G :. •� • •' • • 1T• r M MAW. will•® ..SAMEMS • • • �0©©0©00����®®� • • � L lLI�!„ti�'1M11M'I sl!! it tll 11 1__ FW • • % i WINOW 000110- �Wr r AMI ter- INK FM--NFN-WFN- • • 1N 1_e'��:1�•W -+1'N • • • • IE 1I1�—�._-11L I��l-��.IC���=III--{,"�t'l—i�1' IFMiIl�rc.--..--41T.cT�--_31IL+—�I{L��j�(�'ljL—��=+1L4�JI145i—��+'��Il�� �W I _—��- INFRARED • •L1j—�. '(St—�J'IIr_ lj+'1j—....jlFNK_.'—�I1—�,'1j—��II -'LII—�j�IC��f I11S—�-j frL—�'�IMI^.J��—.'I(C�—F.F —ls�—. +t_IE�S —�.« L�16�1 __.��.-14t'zz�--'�'I�-0 LABORATORY COCKS AI���1.�j����a,,ILr�_—�,,l!1�11+1'{C��l{Il�— I • • UNIT IrrI—��—iil��li+3 FW_ ��v 1l. 1l t.11 .11 +�INKIWK � _-w��--�t'III�-- OVEN I i FW, MWIRM ''Il--�s+171��--NWE MW POOLHEATER LM11. .1I�i:l�+L -+L�--[--.�16�:51��-__ Lam_ .. l''--,!''1�---;'1'•^'�---�,'"-M"11"�—N ROOM/ . 1 t • CE 1I1(([ ---''i {.�.�.lGam:-�_I(-1e raw NO IF_�'1(—�WW 1� • • • • ..—��.'. ljll—��'(l(��j'1�— 'IE—�_J'I1(.—��t1�•'1j. d'lr—�'''I—��1�1..C21�-�LWWt I—��I �—��I'—��I �_ -'I1!_—*jWIn—n— 'If—±L 'lj—��,''(WWWWWW • • • • • 11!.ASCI.lI 11 .IMM-1SMSA=�.1 l ^=lM0 WN LFA"_l=--=NWj INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q]f NO Q� I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 6-6 J` 'LF LIABILITY INSURANCE POLICY E-11-OTHERTYPE INDEMNITY BOND] �� /Nj'v✓'C OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 3 Massachusetts General Laws, and that my signature on this permit application waives this requirement. - CHECK ONE ONLY: OWNER LJ AGENT F 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 compliant all Pe me provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME !%. J`j�-� LICENSE# J,1,-... SIGNATURE t MP LMGF [] JP D JGF [_] LPGI i CORPORATION �# _- PARTNERSHIP#��_ LLC[__11# ADDRESS .. COMPANY NAME: _�'ti C E -�`e'L��C{ -( J S-Z'1'�•�� .._ -- - - -- - 1 -�� CITY%Q/"✓I - _ - - STATE 1/1�_ ZIP [_ M� -,_ TEL FAX SW S",]j CELL _I EMAIL (---.. _ 4 _ L�- SA ~ ' ~ .. ^ COMMONWEALTH OF MASSACHUSETTS LICENSED /\S/ MASTER rLumuBcm |esusoTHE ABOVE uoswesTO: RANDY L SIDEMA.l ° 1431 PAWTUCKET (iVD UNIT 9 / LOWELL Mk 01854-10/ / �� 10149 05/0l/l� l64557 `` COMMONWEALTH OF MASSACHUSETTS ,DIVISION OF PROFESSIONAL LICENSURE - BOARD OF.� PLU L|CL7�|S6OASAJOURNEYMAN PLUMBER ISSUES 7HsABOVE unEmSEro: RANDY i SIDEMAN / 1431 P�WTUCKET BLVD / UNIT 9 « LOWELL MA 01854-107 3N 19774 or'. /01/14 164556 �` 0 No I CN N O 0 py, {{ypp}} i4 z a o W Z LL �;.i,��7�•,•,� 4�(�• r• .. KN,( {/�. �,}}i 'iii• j I '_ IGS•"#�������t •fi.1 ( in rm ru EG r: Ln F3 - Z V. O .. Ir L) 0 0) (7 LO N iH mo LEI x u ru ru . _. O v , 0 I LD Q. j c.0 W ' ru 1214J . 00 I p I a ._ ,'1 U Y h `0 ~l A O Q` o Q4 I 0 127696 CHECK DATE: 09/25/2013 CHECK NO.: 127696 DATE INVOICE GROSS AMOUNT DISCOUNT NET AMOUNT 09/20/2013 Permits -July -Dec $ 1,500.00 $ .00 $ 1,500.00 Town of North Andover $1,500.00 ID 88655 ------------------------------------------------------------------------ MERRIMACK COLLEGE J I a MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 15 -Nov -12 PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas / Plumbing / Electrical WHAT: $250/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6223$750.00 ----------------------------------------- ------------------------------------------ ----------------------------------------- ------------------------------------------ ----------------------------------------- ------------------------------------------ ----------------------------------------------------------------------------------- i MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas / Plumbing / Electrical WHAT: $250/each TOTAL PAYMEN $750.00 Account No. 10-6010-6223 ------------------------------------------ •----------------------------------------- •----------------------------------------- APPROVALS: DISTRIBUTION DATE: 15 -Nov -12 Amount $750.00 N2 9676 Date) TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... ........ I P, has permission to perform A. -KI .... !. plumbing in thepildings A— ..... at ... ..... North Andover, Mass. Fee Lic. No.......... NIP Check # PLUMBING INSPECTOR ..... WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date ��I�.Li Z_.. . L41), TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ................ This certifies that. PP �-e .-..�.°�' aq has permission for g installation 7. in the buildings of... .............. at ..41 '6' .41'6' 4-- ........ North Andover, Mass. 00 Fee? 15. :7. Lic. No.......... M.D.. GAS INSPECTO Check # � mv5I)I5, 84057 c ` Date 1. .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies has permission to perform . ... ,.. Z©�3 • • � �• � � ` ..-n wiring in the building of �-P �t�.a rte. C:�. (.� . � � • at. �� .�f�? .. !r!`?��?- •• • • • • • • • • . , North Andover, Mass. Fee Lic. No.......... ELECTRICAL INSPECT Check # 11241 '* a f 7 A Ln M O Ln O O• O .LnIt41(F(Fh 011 n r� L` I O 1 I I Ln I E -I Ln I W W I z OD I OD I O Q I O H I I Ln I M 1 Ln E -I O I dl O I ptl�ti•FI H Q O I U Ln 1 E , H vi- I OQ I z 1 I x O *LO u O WH I x O U Ln0 II r - } I� I I I: ll l'll iiiiii{(Ii��I�l II � I Q II x II vi - .Q 0 O I N a 1 \ 1 d1M 1 H H \ O 1 rl N I H I �4 1 � I U � 1 Qz\rn N 0, rd rd I P H :4 I :m N -, got I xHh 4-)1 u �4 1 Z`" x r1 Zi 1 u o 1 N 4.4 1 \ O I W Ln I rl I I QH F S. cc C� .a Ln ti V- Ln O E.O Q' m a O m a a O Ul m Ul Ir a Ln .LnIt41(F(Fh 011 '1'W O (ill IFr{ O Illi...... .. Q Ln / OW ptl�ti•FI Z LL j( � d @@�rjj{hIj(Sl *LO rl•up•fI•� r } ll l'll iiiiii{(Ii��I�l 114 Illh (�(Ill��i• Z .Q O F- <; Ori Qz\rn N 0, Z �\ :m N -, Z`" Z, Wx �u �-I v 7 `0 co � °>. 4-4 O r~ z a S. cc C� .a Ln ti V- Ln O E.O Q' m a O m a a O Ul m Ul Ir a MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January to March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6223 ------------------------------------------ ------------------------------------------ ------------------------------------------ APPROVALS: _a AI, v DATE: 13 -Dec -12 Amount $750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------ This certifies that ......................................`.... . has permission for gas installation ej,, �.. e"� ... v( �'?�' PS Zo/L in the buildings of ... F "I "P ,� A . n �! /ti �I �� ........... . Fee PP Lic. No......... . Check # % u 3 4 7 ......... North Andover, Mass. GASINSPECTOR F-� m CD 0 :i. 0 W I 0 nn Om m 0 0 Z 0 0) 0 > X ;:� C:''* :7 0 -4 cn Z-) --I 0 Z c a 0 (a Z 00 0 < 0 (D CL 0 c rn Cf) 0 (D (�D o 00 0 -a mn0 o (D CD 0 (D (n cr 13 (D I m Cl) (D 7 N) 0 Z 0 0) 0 ;:� C:''* :7 0 =3 > 0 0 a 0 (a Z 0 < 0 (D CL 0 rn Cf) > CD > CD o 00 <0 (D mn0 t 0 00 X rn rn m Cl) (D 7 N) r r 03 D3 O it, it, W r w O Ln ru Ln r U3 i. t ro 01 N ..:.� 00 N 0. '. N p � Z o M<- D I 0 Z -C x- W I � � �F O Cb J oa:; Ul Or: <�.. Oeo N O O O • O� <oo:. i K 1y 0 I 10 1 t -h I I 0 I Fj I rt I I 1 I 1 0 I I (D Fj IN H d 00 co 0) Ul Lil 0 �otj 0� N N tij OHx rt 60> (D n m \til .. N O O H N \ 1 N ro Ul c� \ K N O N N 0 Ln0 • H O n C) x z iad0 H• N J H0) 00 0) I ' c,z 01 N ..:.� 00 N 0. '. N p � Z o D Z -C x- W D �F O Cb J oa:; Ul Or: <�.. Oeo N O O V O� <oo:. 1y 0 I 10 1 t -h I I 0 I Fj I rt I I 1 I 1 0 I I (D Fj IN H d 00 co 0) Ul Lil 0 �otj 0� N N tij OHx rt 60> (D n m \til .. N O O H N \ 1 N ro Ul c� \ K N O N N 0 Ln0 • H O n C) x z iad0 H• N J H0) 00 0) I N2 9605 f s Date . AA/ . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ................. n ............. \ ..... . has permission to perform /�- �f. !��°'�.... 1/ .UPS. .. plumbing in the buildings of /�iP.�i/►'►t.cl�, . t:c1/o........ 1 at .....&�.. l N.�?^'/ � c.....�(�7:........ jhAn ov r, Mass. vJ Fee ? ." .. Lic. No.......... A)) .... . A PLUMBING INSPECTOR Check # 76 r WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C m 0 QJ cn CD N) O Ny ou 1-1N O (Z �-x N tq n 0Hx 0�d 10� (Dnm N O O N lfl N � I N ro Ul m ►'i N O p N ij� O 0 JO uln O x yno o x X170 H• n• N J yrn 0o rn V 04 00 ON 0 m => z o �1 -:. W W z N Ul Cl) z oo O D: -1 dl"N 0 �.. o C (n -zq n; 0 D z J may: Ul O N O O �1- ra `. 00 O Ny ou 1-1N O (Z �-x N tq n 0Hx 0�d 10� (Dnm N O O N lfl N � I N ro Ul m ►'i N O p N ij� O 0 JO uln O x yno o x X170 H• n• N J yrn 0o rn V 04 00 ON This certifies that .................. ............ , ....... . has permission to perform wiring in the building of ...�v 10 ..'..'.`?"?G —,��, 5f d at ... !:�. .��1....�? 1�.�. ............... . North Andover, Mass. Fee Lic. No.......... A) ................... ... ELECTRICAL INSPECTOR Check # // 76/ 11126 O D m T n O= rn D 7, > 'i) _-n Oc -I z03,:.. O Op o 0 r�0 IQ CTI N 0 3 0 7 O o"o m m y00 0 m 3 vzs O -p Ol N 0 0 (CD Q �. aD c 3 m E (D N 3 D a (D 6 CD or O 0 CD CDUl O D m 03 C-3 ! �, O • (D n ti r ,a T n �F r trt 00 ..::;:> pLA .;,. z O C �1 "c 7 V. • C � 03 C-3 ! �, O • (D n ti r n �F r trt 00 ..::;:> pLA .;,. z O C �1 03 C-3 ! �, O • (D n O Fry 0� N o . (j N [x 0 p nW N O O N to N \ N ro U, (D \ F1 N O N N ij� O id O (a -'1O Lri ox HW o (� O x ado H• n �H N J F3 rn Ib rn V 011 00 O% W n �F .;,. z O C �1 "c N lil Ca �\zz ;0)Nt7...::;0 Oo O D: srI 61 C. N z 0 z �F �F cli w D j � Al 2j Ul �'- O 0 O >E V O� 00 :. ov. O Fry 0� N o . (j N [x 0 p nW N O O N to N \ N ro U, (D \ F1 N O N N ij� O id O (a -'1O Lri ox HW o (� O x ado H• n �H N J F3 rn Ib rn V 011 00 O% W Iw' I C _ -n >O .. ;o �G) N � U1 O - 0-0 o� m �CT m CD 0 CO 'n 0 O= �m n -qcn z)- —i z w 00 cD m O 0 CD o3 ~ 3 Icr C -o O 0 rn .o O O D D o o 0 0.. 000- cn aCl) s rn D m o 0�CDCD co m� � n 01 � o �m G) rn a a m T Cl) co If Date OF NO n qti a TOWN OF • ANDOVER PERMIT FORINSTALLATION �s4 ACHUs���y This certifies that .................. . has permission for gas installation Z/'� /1q'e,x,_ in the buildings of ... �'oE' i?? ��z, 0-A at. �. �!�!'�^-p� fes.f , North Andover, Mass. Fee a'�' 00 Lic. No.......... !�%% ..................... . GASINSPECTOR Check 8347 I N° 9605 Date. A/41//Z.. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that .................. ..... . has permission to perform 1�^/ '�..... • ..�' P • .. .Z" �Iplumbing in the buildings of 4&,e1).ft4'_C4. � ...... . L at ....1.. f �.?^`?. • ���: • • • • • • . , North Andover, Mass. FWW .. Lic. No.......... !y4- .......... I ................. PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date AA/21... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies tithat .................. ............. \ ....... . has permission to perform '&" -'�'' e'?u?� ...�!.— ..... v ..- wiring in the building of.. f 'e'e0F?Q&iL ..erel e at ... !C .............. . North Andover, Mass. FeeQ�3?.jLp .. Lic. No.......... A51 ................... ... ELECTRICAL INSPECTOR Check # 11126 34 r r X f? Fd f [33 I i o � m 0O o' l - 0 0 H� - z i [33 o 41,ti m a o. �o d \ m tIj \ N 0 n N ttij 0 �o� (Dntil nw• \ N O O N w N \ I N ro ul m \ ti N 0 F -I N O m JO Lr'rn O oyn O ado ON J 1-3 m co O O {a Z F-3 o y 0 V O1, co Q% [33 o m a - 0 .: K o r i LW C) m W z iCh \C lZ"., O NV1� D_ I --J \:;z z LP coo D: -i C)) N n :...: X. -.7 N O c ru Ln r � � I IIIA, D7 ) I�I.I ,., ZG ! IIIId�Iii j I# � 1 I�I�tl�•��I I I I) Int. •�a) ,;.: cjl W r m Z Ln IIII'I, O i _ ,UI I I �I �1 •I O II Oo I o. �o d \ m tIj \ N 0 n N ttij 0 �o� (Dntil nw• \ N O O N w N \ I N ro ul m \ ti N 0 F -I N O m JO Lr'rn O oyn O ado ON J 1-3 m co O O {a Z F-3 o y 0 V O1, co Q% Date TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING This certifies that ..4.P�P m a "'/ � /f? -e- ,% . has permission to perform .4/'O'e- % J;/O/ . �6'Q-.P�'n! /- 6A-/-' wiringiinn he building of ../ 7 Z ...... .. ....... ....... �- Andover, Mass. Fee :Sw .. Lic. No.......... '�'% ..... .... '. A ELECTRICAL INSPECTOR Chek # 10911 ft'J eLk — Fy-T I Ree-0-aca MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 12 -Jun -12 PAY TO Torun of North Andover - 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: Apri! to June $ 750.00 July to September $ 750.00 Own It, lfa" FOR Gas, Plumbing, Electrical WHAT: $250 00/qtr TOTAL PAYMEN $1,500.00 r r Ln r X r O r � r W i r W X O Ul ru Ul Ila a s � O I (D r n • f -• i j C1 � x* ! ti Z W W Z C <. Fes' N ..:.0 l0 O D iA' N n -1 C z o I y -1 4, z OK, ait 3,�.j N m p z -4 w a, ,iii•<�i; U1 W. m Z 0//Z --r........ Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that At- /IeI /Y►eAC�c. L ........ 1 --has permission for gas installation.�AA;-0 .3.I/.............. . in the buildings of .. �'�!/�'?a 4- ..� A;-0".......... . at ....4�1� ./G i? �,� •%u ........ North Andover, Mass. Fee�W.A. Lic. No.......... . Check # / / 97 8221 f%t�r....................... GASINSPECTOR MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Tjqyv 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June $ 750.00 July to September $ 750.00 A-44674 �'R' A. -Ow- nil 411L 41 FOALGas Plumbing, Electrical WHAT: 0.00/qtr. TOTAL PAYMEN $1,500-00 Z- DATE: 12 -Jun -12 w d' ON Ln r� Ln Ln HO • H OQvl- z x O U O o U O O Ln r --I O �ia- N r -I O N �q \ N O w N I \ N w H O O N WU 04 40� UH W N U o N Q \ O Ln I Ln I w I 0 I c I I AI H I 0 'I O or a �o O O S� Ln qqS 1 y Ln ]< �I li .I�j1�1 r1F(I 1144P l 6 ca j i.l d Yl D Ln D .,. O N ry N U H :. .'Q O 0) LP o z z ,� Ln Q' m m } oO '• of.: O i O Er HD. ,k : irri I -n i • I i �' N � a w . I 4jco Ln .-■ .. - w44I v � 3 0 w>: .-a l `I 9457 Date TOWN TOWN OF NORTH ANDOVER PERMIT.FOR PLUMBING ,sSACMUS� /I This certifies that .� i.......a 4. °.� �'' ............. /f has permission to perform ?!��1:?-.l . `f�?� .�d //���` plumbing in the buildings of .. ,e!e!h?a /G ..t•'•,/��te.. at... .. !''�'.'�C...! ........ North Andover, Mass. Fee �J . Lic. No.......... A14 ........................... PLUMBING INSPECTOR Check # ���� 'j" - 1V I i,,,j ej 1 .12-& j � Z-- MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: T@W Andover -' A i ' 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June $ 750.00 July to September $ 750.00 FOR Gas,, WHAT: $250 TOTAL PAYMEN $1,500.00 Cal DATE: 12 -Jun -12 PN Is JL' d' a Ln a+ m H H Ln H HO U • H 0QV)m ,`4 O U 0 U0 0 LnH U] O L7 t/2� N H 0 N S -I 0 w N I \ N w H 0 0 N W 04 �O� Q a UHFC U 0 N \ WN Q k.0 0 Ln I Ln I � 1 O I w 1 1 Q I H 1 0 1 0 I Ln i I H I � I W a 41 C.7 � (El d' Y 44- O > o 111 II II� E z �+ 0 (I tI)Sa 0 �} O Iplyi''' >m 0 LO 4 IiS� Sl 3. SI Ow �p(I �I rl �l•.{It Co. In f il !�I•�I �I I��4 (4jf.ul7p.(Ll/ ZQ fjjjllp(�(��yl( II(Iyy O U I- z f to _: D O N' H N' O 61 Q Q z \ Ln 0 ri Y it N H m } O' W k '� O ro W a 41 C.7 � Y 44- O > o R E z �+ I cc 1 � Ln ru Ln O I O O M ! .a ! O I ■_ 1 1 I fT a I Ln r. MERRIMACK COLLEGE PAYMENT VOUCH�F PAY TO: Town of North ,Andover: y 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June $ 750.00 July to September $ 750.00 FOR Gas, Plumbing, Electrical WHAT: $250.00/qtr. DATE: 12 -Jun -12 TOTAL PAYMEN $1,500.00 4 #",/ ev 61,... (/26/rZ ot. 6/2- 6/z ewolCL r It CN LA d' r -I E-1 Ln r10 ..� •H Z Q V)- x O U o Ui)O ri L7 m O N ri O N �-I \ N 0 w N I \ N l0 r -I O O N Wa E-1 H U1 Q ID UHFG U o N WN Ei H r.G \ Q� 0 Ln I Ln I W I w 1 OD I A I H I H 01 01 Ln 1 . 1 H I � I �4 1 N I I 0 1 I I I I I 4..) 1 I Z I I 44 I 0 I 31 01 Eq 1 vi • �4 LA;> N O 0 O y o< O O J � 111 FR O w H ic M ,k Lo k } z a - o U, Z w N O d1 GJ � 3F .C9,:N 0 H .' Y Q Ix m . v/ O4 0 Z . Z) H W�- vi ■ { cc o- Ln ru 1 L' - Ln o I rm i rn { ❑ i 1 Q' Ln • �4 N 0 h U w GJ 3F v` v/ O4 0 Z < Cl,. ■ { cc o- Ln ru 1 L' - Ln o I rm i rn { ❑ i 1 Q' Ln t Date-'�2/! Z• TILF:U j • TOWN OF NORTH ANDOVER PERMIT FOR WIRING Jv� r CSD This certifies that . 4.- . •f a • • • • • J' • • • ' • " " " " " ) hasp ermission to perform .4.�� wiring in the building of .. ... • • . .. 2 ��' 1�`' ' ' ' ' ' ' at.. . ('��''��" �` %�' • • • • • • • , North Andover, Mass. Fee �✓a: . Lic. No.......... 1'14 .................... ... ELECTRICAL INSPECTOR Check # 109111 f . Il a, If Date TOWN OF NORTH ANDOVER PERMIT.FOR PLUMBING This certifies that ................ C�_ 0 . . has permission to perform plumbing in the buildings of ....... at ...2I. J.6, Y ........ North Andover, Mass. Fee Lic. No.......... IV46 ............................ PLUMBING INSPECTOR Check # 1151 ?Ll— Date .Z�/�2-=- ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION -1 ..... / 4 /)," 6, /4 This certifies that has permission for gas installation le in the buildings of ?X11 1114LA 4 t4 at .... i e, North Andover, Mass. Fee�U4*0 . Lic. No........... 1�4 ....................... GASINSPECTOR Check # 8221 rt Date........ -.24.....1 - r2- ...... I TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ......... M ...... . .. . .......... has permission to perform . wiring in the building of ...... .7- fL.E S'/ at ....... Iq .............................................. North Andover, Mass. .. .... ... ..... Fee .J,r- !��. Lic.No .............. .................. ' [LECTMCAL . INSPECTOR ... Check# It vCqtq 10616 iy m CD 0 0' v 0 O m �m n DX �-4 O c .. C- O 7 � C � N CD M o � m 3 =Tl(n 4/ r i - 1 WIN O Z O O O � O 3 , D O o cn 0 O "cn> 0 0 K> CD oa o .� co CD Cnn n C �C n r c� m v D m N L v N i - 1 WIN I IS -0 . z m ;u 0 C 0 0 ;u ;u 117 z 0 0 X M G) rn n ` I O = �m n O c zW c c v CD 0 CO D ,dt r T 9 m _ m �0 o N CD O o c a cin o 0 CD 0 cQ m 7�D m v� D m co 0 D 0 n ` I O = �m n O c zW c c v CD 0 CO 1 ,dt o- z0)a �0 o , O o a o Z CD CL m 7�D v� D m a D C) o co z n C n r � m m v n m N L v N 1 ,dt r .. `I 0652 Date ... .-........ .... . t ry TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �. This certifies that ....... ........... ......�................,DIL has permission to perform ........ y4 .... 9:4*,t k.&7 ........................ i wiring in the building of ......... MAA /1if . ................................ at ....�5 ...... U/..........� ............rth Andover, Mass. Fee, ................ I c. No.............. ................................ ELECTRICAL INSPECTOR Check # 16�� Commonwealth of Massachusetts 'Department of Fire Services BOARD OF FIRE PREVENTION- REGULATIONS Official Use Only Permit No. Permit Fee Assigned [Rev. 11/991 (leave blank) ,�v -`_APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 'alFOR INSTITUTIONAL* USE ONLY so This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws, stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: October 31, 2011 City or Town of: North Andover, MA To the Inspector of Wires: By this application the undersigned gives notice of the on -premises performance of electrical work by employees. Institution Address 1) 1 0 1 V "1% yn� >r. Location and Nature of Proposed Electrical Work: NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion (check one): YES ❑ NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES ❑ NO V This option is available where so contemplated by the municipality. In these cases, you must renew this application annually, and upon significant changes in employment. The following individual(s) will be responsible for the accuracy of the log(s), if maintained. You agree that the log(s) will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage, and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure, indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 3 Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff, under their direct supervision (see c. 141 §8)? In general, this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans (see St. 1962, c. 582 §3 as amended by St. 1979, c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons, not required to be licensed, do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 0Full-time equivalent electrical employment: 0 *Institutions are defined for these purposes as any person, firm, or corporation operating under c. 141 §8. (Please see reverse side for certifications and required signature.) .Institutional Permf4�Form�page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If, by the terms of such a contract, you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the premis- es of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of au- thority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board, or in contravention of the Massachusetts Electrical Code. My title is: Physical Plant — Merrimack College My authority to act for the aforementioned institution is: Merrimack College I certify, under the pains mad penalties of perjury, that the information on this application is true and complete. (Signature)(Dated) 1 ! 3 1( (Print name) Robert Coppola — Director Physical Plant (work telephone number) (978) 837-5118(extension) (facsimile number) 2-g7� COMMONWEALTH OF 114ASSACHUSE' ELECTRICIANS AS A REG JOURNEYMAN ELECTRIC. ISSUES THE ABOVE LICENSE TO: JOHN R DEMATTEIS 8 WILSON LN WESTFORD MA 01886-17 28794 E 07/31/13 8224 71 Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSET-1 S 'ELECTRICIANS REGISTERED MASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: DEMATTEIS ELECTRIC JOHN DEMATTEIS 8 WILSON LN WESTF,ORD MA 01886-1 Fold, Then Dctcach Along AH Parfor ions /[10M, vIlt'-- k r1E5 - %COMMONWEALTH OF MASSACHUSETT ..ELECTRICIANS AS A REG JOURNEYMAN ELECTRIOI. . I . I - ISSUES THE ABOVE LICENSE TO: JOHN R DEMATTEIS 8 WILSON LN WESTFORD MA 01886-17 28794E 07/31/13 8224 Fold, Then Detach Along All Perforations COMMONWEALTF1 OF MASSACHUSETTS ELECTRICIANS REGISTSSERED E MAS ABOVE LITER ELECTRICIAN IUES THCENSE TO: DEMATTEIS ELECTRIC JOHN -R DEMATTEIS 8 WILSON LN WESTFORD MA 01886-1 Fold, Thsti Dettach Along All P?rforat'ons COMMONWEALTH OF MASSACHUSETT • • itT:Tild.`I.9[•l�(91�[•3�i6Y�1:1:1; `: • -. • ELECTRICIANS AS A REG JOURNEYMAN ELECTRICI ISSUES THE ABOVE LICENSE TO; JOHN R DEMATTEIS 8 WILSON LN WESTFORD MA 01886-17 28794 E 07/31/13 8224 Fold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS. ELECTRICIANS REGISTERED MASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: DEMATTEIS ELECTRIC JOHN R DEMATTEIS'" 8 WILSON LN WESTFORD MA 01886-1 12476 A 07/31/13 822420 Feld, Then Detach Along All Psr'ore cr> Tt/ , , /,/, 5 7- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: /- _ f 616 e� , MA. Date: Permit# Building Location: h,p �� Owners Name: Type of Occupancy: Commercial ❑ Educational [/ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name- /1�iA�"05 .I' Address: L O wt,'L(. City/Town: L 0'"'6Lt- State: AA �lesy Business Tel: L�� �i- ys —y�Sy Fax: Name of Licensed Plumber/Gas Fitter: , f /Dl= ,,AN uneck one Only Certificate # ❑ Corporation ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this' permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner E] Agent By checking this box ❑: 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 1429f the General Laws. By Type of License: [2 -Plumber Title ❑ Gas Fitter M'Master City/Town ❑Journeyman APPROVED (OFFICE USE ONLY) ❑ LP Installer Signature of Licensed Plumber/Gas Fitter License Number: _,/`jA J -Yl ) Q 1 L) / • V MM M ' MMMiN MMMMM ���� mmm MM MM MM MW - MMMM ����������������������� N Installing Company Name- /1�iA�"05 .I' Address: L O wt,'L(. City/Town: L 0'"'6Lt- State: AA �lesy Business Tel: L�� �i- ys —y�Sy Fax: Name of Licensed Plumber/Gas Fitter: , f /Dl= ,,AN uneck one Only Certificate # ❑ Corporation ❑ Partnership ❑ Firm/Company INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this' permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner E] Agent By checking this box ❑: 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 1429f the General Laws. By Type of License: [2 -Plumber Title ❑ Gas Fitter M'Master City/Town ❑Journeyman APPROVED (OFFICE USE ONLY) ❑ LP Installer Signature of Licensed Plumber/Gas Fitter License Number: _,/`jA J -Yl ) Q 1 L) / MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: �- ( yy�/�. MA. Date: /6 11 permit# /� a _ Building Location: /S %rr,�,g C & /�j� 9� Owners Name: Type of Occupancy: Commercial ❑ Educational [ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES DEDICATED LU SYSTEMS > U h z b W z 1Q Y 'Q c U w t O ra aLn O m v cac Fw- in ¢ v~i Lu w o LL ►_- a W o 0 o W Z W 5 z A LL a w U F 2 n0. O= 2 ~ �` '' Q S w w of O w 3 Q Q y p F- v O j O p a z cn w n w a m CID o o LL x° Y g 5 �° z° 3 3 3 0 ° Ln W a y -SUB BSMT. y N a Oere- BASEMENT lsr FLOOR 2ND FLOOR 3RD FLOOR 4r" FLOOR 5r" FLOOR e FLOOR 7r" FLOOR 13' FLOOR Installing Corr puny Name: _ �j�-ti'®C, J �M �YPrA,Ac,C Chc,k 0rie n:i;y C6rtifiCatc l' Address?? //�'•'CVGjIcT u'1^i.� % � v ❑ Corporation City/Town: State: � Business Tel: U1II El Partnership L•�%•- ��i- LOS- Fa : �� ��� OCS` ti0i. S'1D ,�.,a.V /� ❑Firm/Company Nam OrpLlcenSed Plumber: / n�,jjj��� -vin— I INSURANCE CEnvGnnr`e. v have a current Iia__ bility,insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No If your have checked Yes, please indicate the -type of coverage by checking the appropriate box below. SEL -l' A liability insuranceolic i r's'�� p Y' ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's A ent Owner ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate + a 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. s ra,e to the best o. my By Type of License: Title ❑ Plumber L'Ity/fown E;�fftster APPROVED (OFFICE USE ONLY) ❑.lourneyman Signature of Licensed Plumber License Number: /f1A J"JYl )G / C / 9► 56 NORTH O 9 ,SSAC04US This certifies that Date ./.Q/G /—" . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ...7..q.r plumbing in the buildings of ..,!`,�P. { r� tr�4 �...�i� y .... . at < ln� .. -1 .. . , North Andover, Mass. Fee .Z:v , <). Lic. No.......... �' :�.z-...... . PLUMBING INSPECTOR Check # 78`/ Date .AA(. /. !!......... . O TOWN OF NORTH ANDOVER � A ' PERMIT FOR GAS INSTALLATION • • a ,SSACHUSE� t This certifies that has permission for gas installation r' in the buildings of .../yP�r,,r��G at ..... 7Z:t7? A ��.... -s'T . , North .Andover, Mass. Fee..Z4 .4P Lic. No........... GAS INSPECTOR Check # �Gt— r W a 0 LO "I" fll OC) Q ,. O a (1) a Qrr�^vJ ^ � L O 01 p O Z w U C O 0 a c O L O O f— �- z O r a fll u) E fv U Q d O cu 00 m Z � 0 W 20 V LL z m i 0 f 0< LL = Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........................................................... ...................... has permission to perform �� '.........................................f a `'�" ..............`,o........................ wiring in the building of .. � �'.. r( //°.. -� .. ............................................... .... ..... 17 3 f f l'' /I'� ` ... , North over, M ` Fee.Z}..U...... Li No. ! � d`�. ............. ..;,I ..... %..... ELECTRICAL INSPECTOR iCheck # _____ MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 7 -Jun -11 PAY TO: Town of North Andover 1600 Osgood Street r North Andover, MA 01845 0l-7% [PURCHASE 'ORDFR tlU:'.S2EFi _ ....._......"___� _.... CHECK STUB Quarterly Permits 3 INFORMATION: July to September ! i - r FOR WHAT: Gas, Plumbing, Electrical $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10 6010.6223------------------------- ----------$750.00 --------------------- • ------------------------------------------ ----------------------------------------- • ------------------------------------------ ----------------------------------------- - ------------------------------------------ ----------------------------------------- APPROVALS:�, —� IL i' 897 Date.6—j3'1) TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING M� L 2R. \ Yv\ YV— c, C o L-� � F This certifies that .. �`W. has permission to perform plumbing in the buildings of .. ('(X IkA(- L- °�--.4.L at.1 VtLC� \O\v ( ................ S�vtRa , No h Andover, Mass. . Fee.a .%Q-0. Lic. No .......... ... .. — (..... ........ . PLUMBING INSPECTOR Check # 7 6 y ..r Date... ...... Mvw ry Of.,io ,ti0 TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION This certifies that. YIA.�.�LAl.t!n.l?c.�....C. C�.�t...::.6.C-........ has permission for gas installation .. in the buildings of . LMQKA c.,:......... at 3l S.. 'T.QA-?`'.P V.L. Sr!� �.... , North Andover, Mass. Lic. No........... � • GAS INSZ O Check # d. Date .. .......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ...................... ........................... ................................ has permission to perform .................................................. ........... /K.. wiring in the building of ... ............................... .... ............. at.................... ................... .......... : ........... . North Andover, Mass. ........... 1. .......... ....................... Fee..�; ................. Lic. No.... ..... . / ELECTRICAL INSPECTOR Check # lq --3 3/ ,�« �° � �PIU\ 2-ol� A. 0 0 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR WHAT: Gas, Plumbing, Electrical $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 7 -Jun -11 / PURCHAC;E OPDF5L N:'AlBER Account No. Amount 10-6010-6223 $750.00 ------------------------------------------------------------------------------------ •----------------------------------------------------------------------------------- •----------------------------------------------------------------------------------- APPROVALS: �� � L: - 10S 3 3/ ������ �� � o -33 elf- iaS33/ 0 9950 Date ......... 'ORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.... . ........ .............. C vim, has permissiordlpe ......... al.........&Axee.�1.......................... wiring in the building of ......... at ................ S-j�� ....... North Andover, Mass. - �Jki Fee ....... Lic. No . ............. ................ ao. Check # -E6C;;ZCAL INSPECTOR MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: Apil to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN Account No. 10-6010-6223 -------------------- -------------------- -------------------- APPROVALS: $750.00 DISTRIBUTION DATE: 3 -Mar -11 Amount $750.00 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: Apil to June ZO kk FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6223 ----------------------------------------------------------------------------------- ------------------------------------------ -------------------- - APPROVALS: DISTRIBUTION DATE: 3 -Mar -11 Amount $750.00 r 0 ru r w O It - It, r W O it, W X O i■ i O Lnti Ln r 133 0 ro Z Ort 0 E' o O iA CA. T. D `" ml cel Naz;: :><' Z : ml ul y C I <= J N Cl'.. o 071 0 0 ; F -h r z 0.:..' c 0� � I J rt x Z I O i -G I I O I O I I O j el I I � _ 0 \_C Z Ort E' o O iA CA. T. D `" ml cel Naz;: :><' Z : ml ul y C I J N Cl'.. o 071 C, , 0.:..' � I J D Z I O -G I I O I I O j I tj 'E a z w I 00 m o z 1 I 00 dl J D ::.; I Ul U-, D o ,' I Ul O N 1 o I I 0 O O tij H V' O wd 01-3 w tz7 N O C� � x C) OoHx N F'Oy C) til M.. O Lo O N O N N O JO oF-3tlj �x C) CC) o x ado H - C) N O N H� w O O tij H O ul y C o o IL `' INSPECTIONS SERVICES LOG DATE: C&I"'7"y'4"y ;9 X11 ADDRESS fv 70 VS ,6')d RINSPECTED BY: NAME � 'J Z-64 `4 y l L°S f�l!%i`I tJ/ DATE OF INSPECTION: PHONE CORRECTION NOTE/ INS ECTION COMMENTS: PERMIT # OFFICE NOTE: PASS FAIL OTHER )NE INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME ROUGH FINAL OTHER T IN: TIM OUT: CORRECTION NOTE/ INSPECTION COMMENTS: PERMIT # OFFICE NOTE: NAME INSPECTION REQUEST: ESC/FOOTING FRAME PASS FAIL OTHER PHONE /FOUNDATION ROUGH FINAL OTHER 1 TIME IN: TIME OUT: NAME p PHONE (-7 ^ASS 3 �' PERMIT # OFFICE NOTE: INSPECTED BY: DATE OF INSPECTION: PASS FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: N REQUEST: ESC/FOOTING UNDATION FRAME i FINAL OTHER _ TIME IN: TIME OUT: ADDRESS O V 11 t -.,V r'`: NAME./1/J P""1NE I _..MIT # OFFICE NOTE: INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME ROUGH FINAL OTHER e� a INSPECTED BY: DATE OF INSPECTION: PASS FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: TIME IN: TIME OUT: ADDRESS z NSPECTED BY:, ,0 NAME DATE OF INSP PASS FAIL OTHER PHONE CORRECTION NOTE/ INS ECTION COMMENTS: PERMIT # OFFICE NOTE: ^� �/ INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME ROUGH FINAL OTHER T IN: TIM OUT: ADDRESS INSPECTED BY: NAME DATE OF INSPECTION: PASS FAIL OTHER PHONE CORRECTION NOTE/ INSPECTION COMMENTS: IIT # OFFICE NOTE: INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME TIME IN: TIME OUT: ROUGH FINAL OTHER . Wun a QpWVuvua iV w uu II SPECTIONS SERVICES LOG ADDRESS NAME PHONE PERMIT # OFFICE NOTE: INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME ROUGH FINAL OTHER DATE: INSPECTED BY: DATE OF INSPECTION: PASS FAIL OTHER CORRECTION NOTE/ INSPECTION. COMMENTS: TIME IN: TIME OUT: INSPECTED BY: DATE OF INSPECTION: PASS FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: TIME IN: TIME OUT: INSPECTED BY: DATE OF INSPECTION: PASS , FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: TIME IN: TIME OUT: ADDRESS NSPECTED BY: NAME DATE OF INSPECTION: PASS FAIL OTHER PHONE CORRECTION NOTE/ INSPECTION COMMENTS: PERMIT # OFFICE NOTE: INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME ROUGH FINAL OTHER TIME IN: TIME OUT: ADDRESS INSPECTED BY: NAME DATE OF INSPECTION: PHONE PASS FAIL OTHER CORRECTION NOTE/ INSPECTION COMMENTS: PERMIT # OFFICE NOTE: INSPECTION REQUEST: ESC/FOOTING FOUNDATION FRAME o TIME IN: TIME OUT: ROUGH FINAL OTHER Fnrmc incnnefin gnin 1 J 1 I 8 W J J O V L QLL z � a W z T T a CD co 4 T W H D I � I I to L T Q Q�� N� t:a a� E o co a o 0OQ L I° CO O Tz. 00 FO mz a wM .-a =O U Z V Ln 0. o ,�4 r'-' H m°' a o a, ,r CN moi+ ❑ N H 0 ■ = Z d' (N rl CO Ir r rl . U O W rrl 0 I Ir ol W +� O a W ` W C P4 8 W J J O V L QLL z � a W z T T a CD co 4 T W H D I � I I to L T Q Q�� N� t:a a� E o Z o°� a w c a o 0OQ L I° CO O Tz. 00 FO mz a wM =O V z A 9846 Date..I- 2- Z. 10 ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ .................. ......... .... ....... .. .. .. ...... has permission to perform .............. ............. ... ........ wiring in the building of ......... P, W.- 4 . .......... at... Tv-&f;-Pz1,r ........ S./ ................ N rth Andover, Mass. c. No.....��X ................... ... ..... . ... .... ... .. Fee ............... Li CAL INSPECTOR Checkq 14V5 11 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Stsreet North Andover, MA 01845 DATE: 7 -Dec -10 CHECK STUB Quarerly Permits INFORMATION: January to March FOR Gas, Plumbing, Electrical WHAT: $250.00/Each TOTAL PAYMEN $750.00 ih DISTRIBUTION Account No. Amount 10-6010-6223$750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------=----------------------- ------------------------------------------ ------------------------------------------ APPROVALS: .6� G'R� 1( 0 7524 Date./ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... /we'k, U a!� ...... .............. has permission for gas installation ... Ay" o e? ' r ............... in the buildings of....... ipw ................................. at 4�••�• . . .. , North Andover, Mass. Feeo?.470. � Lic. No........... ...... G INSPECTOR Check# /"S—le - 9846 Date .... IZ- 2, �- /(-�2 ............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that............. Vit .......................................... '17- &AAe-57 . ........ has permission to perform ................ / ... 5 .... ...... & .............. wiring in the building of .......... kell e ............. at . ........ rh Andover, Mas. Fee,9';'. �—Lic- No..... (.d ......................)... ELE iCALINSPECTOR Check# 1w Date. NQRTH o •1�c TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ... • • has permission to perform ..... .<.- ............... plumbing in the buildings of .......19 W' `................ at ...3. I G.• 1i,�Z '�• • • • • • •, North Andover, Mass. Fee 0... Lic. No.......... ........... . PLUMBING INSPECTOR Check # 40 T SS, Date. (. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .../V/ �. (. f .': ........ has permission to perform ....... ................ plumbing in the buildings of ..... � /I ................... at. ...........North Andover, Mass, ... Lic. No .......... ........ ....... LU M B INSPECTOR R Check # I? P.4..`1 7371 Date..e�0`.�/!4......... I 3? yi .... ,e•e OC f1. o n TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..../P �. AP -!, n .. • , , , .. , has permission for gas installation ...11. ' -1 ............... in the buildings of lt :.................... ..... . at ..1.). �.�! .............. . North Andover, Mass. r _ Fee. ? d Lic. No........... ..::.. ......... " 'GAS INSPECWR Check # C, 7< <. x;56 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-601 ^v ;223 ------------------------------------------ APPROVALS: DISTRIBUTION DATE: 3 -Sep -10 Amount $750.00 --------------- ------------------- 10/05/2010 11:48 .y 9788375065 PHYSICAL PLANT MERRIMACK COLLEGE EAyMFNT VOR PAY TO: Town of North Andover 1600 Osgood Street North Andover; MA 01.845 CHECK STU _Quarterly Permits INFORMATION October to December FOR Gas, Plumbing, Electrical WHAT; $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6223 ........... .......... ------------------------------------------ APPROVALS: PAGE 01 DATE: 3 -Sep -10 9-0/ l Q Amount $750.00 ------------ .R Date..4// 0 . NORTh 1 °. :•. ° TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • s ,SSAOMUS� s This certifies that .. .�C/�A'/�•��A�L ..C' t� �� has permission to perform ....... Jo %?40V 1� .. . plumbing in the buildings of ..... Slt.'O '. .................. at. ' '/.1--• ... • • • • • • .. , North Andover, Mass. Fee . Z)" q .. Lic. No.......... ` UMBING INSPirT Check # 9643 Date ....71 PYAd. .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ...... ................ has permission to perform .......... ........................................... .... . ...... wiring in the building of .......... �. ................................................... at .... 71J; ....... Ce ................. . North Andover, Mass. Fee .23 Lic. No .............. ........................ /A17 ........................ EdRICAL INSPECTOR Check # In-cr-2 7371 Date.. ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... PfR . ....... has permission for gas installation .. . .............. in the buildings of . . . ........................... at .30 ..... ........ ....... North Andover, Mass. Fee. Lic. No........... GAS (:INSP C R Check# 9 2e' e,- 7 7 6 01 Date.. % 1./Zl! ........ p: aao ,sae OL TOWN OF NORTH ANDOVER PERMIT FOR GAS_ INSTALLATION This certifies that .....�%! has permission for gas installation .... )P.1 -A ........... r in the buildings of ...1. :. �� : r :.? .. �. ; .:....... . tat ............. North Andover, Mass. j Fee. ? /Lic. No...........�, .r ........ . ,GAS INSPE0 R Check # G 1 i Date.3/.� ..... 8815 TOWN OF NORTH ANDOVER .* �+ .•.! ••'• °oma PERMIT FOR PLUMBING This certifies that has permission to perform ..................... plumbing in the buildings of ... Al. 'r.. .� f } .- at.. 6' ......... , North Andover, Mass. Fee .2_.)w .'Lic. No.../ ...... ........ .e r v ...... . PLUMBING INSPECTOR Check k f fi MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: Apil to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6223 -------------------- -------------------- -------------------- APPROVALS: DISTRIBUTION DATE: 3 -Mar -11 Amount $750.00 ------------------------------------------ 754 Date.!�..... 3? TOWN OF NORTH ANDOVER ;oX PERMIT FOR GAS INSTALLATION This certifies that .... LT /t f `! .. . c c T has permission for gas installation ... ,&;7.14 ! ` ............... in the buildings of .......1,/y?: `........................ . at ... 7.. -a:lt fv?t h. T .. {...... North Andover, Mass. Fee r). ... Lic. No........... ........: �_�.. ........ . GA; INSPECTOR Check #leqv-S-le Date. 12 .2 � 8M NORTq 3?�. <,•� ;..'�oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... .!1 !? 1.I.=.... � l.. �. C . has permission to perform ..... )1, plumbing in the buildings of ...... �.. lt:..` ................. at ... 7. !.G .,h, e , /7.i. �......... , North Andover, Mass. Fee Lic. No .......... ...... ..1.- .............. PLUMBING INSPECTOR Check # / w �w MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 7 -Dec -10 PAY TO: Town of North Andover 1600 Osgood Stsreet North Andover, MA 01845 CHECK STUB Quarerly Permits INFORMATION: January to March r FOR Gas, Plumbing, Electrical WHAT: $250.00/Each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6223 $750.00 ------------------------------------------------------------------------------------ APPROVALS: I Date 6/a y l TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. ,%7C/1.�i.�.%??(��. -G. •� • ��`• has permission to perform ....Al,eelf'?. . } plumbing in the buildings of ... �??r!`/!9.................. . at. �. �� . .�. l� hr1.� �......... • • • • • • . North Andover, Mass. Fee .2.� D ... Lie. No .......... ..... t1 .. � ... ,..1 ......... PLUMBING MPECTOR Check T 5 2 8351' ;t MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover,MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 14 -Jun -10 Account No. Amount 10-6010-6339 --____---$750 00 ---------------------- ------------------------- APPROVALS: Date...? %/.!.U........ p• to ,° ryp 3? °` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . 9 Z This certifies that .. A�11T.'011-.A. �.!? r .G• CG C (Ti has permission for gas installation .... . . .............. . in the buildings of .... f /-- e�:.............................. . at ...3o.. `.........., N� Andover, Mass, Fee. 2 f �... Lic. No........... ... .� ...... ......... GAS INSPEC OT R Check # ;')—Y S '- 7269 7269 r MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover,MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 14 -Jun -10 Account No. Amount 10-6010-6339$750.00 -------------------------------------------------------------- APPROVALS: . 9646 i Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ...... ................. has permission to perform ........... ...................................................... wiring in the building of ...........A?..{.................................................... � at ....7! 1........¢ ...............'z....................... . North Andover, Mass. Fee..2.5—.............. Lic. No.............. ......................... /I ....M ............................. ELECTRICAL INSPECTOR Check # —?Z'C C/- ? At 6366 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010=6223 ----------7------------------------------- ------------------------------------------ ------------------------------------------ ------------------------------------------ APPROVALS: DISTRIBUTION DATE: 3 -Sep -10 Amount $750.00 9 4 Date..0 -Yh°.......... t NORTH '1 3?�•_'��•�'••.' "°O� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that , `r ? H �' �' ` �� �—` .......................................+�................................................... ��i� has permission to perform .................................................................. wiringin the building of .......... 5...................................................................... at ..... �..� /...4 ''�' l " ........... ,North Andover, Mass. ....... ....... ........................... Fee ..2)-0........ Lic. No .............. ./�...................... ftECr iCALIN'PECMR Check # F MERRIMACK COLLEGE PAYMENT VOUCHE PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover,MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 14 -Jun -10 Amount $750.00 ------------------------------------ /,9 Date.................................. 0 - TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. _J has permission to perform wiring in the building of.................................................. ............ `sem at �............................................................. . n . ... . North Andover, Mass. Fee Lic. No .............. ...... .. .......... ........ t� Cl;�i�AL 11;SPE Check# 9311 r MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 Norh Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00 Each TOTAL PAYMEN $750.00 Account No. 10 -6010 -6339 ----------------- APPROVALS: DISTRIBUTION DATE: 16 -Mar -10 Amount $750.00 Date .. � �. /........... o? °" TOWN OF NORTH ANDOVER F A +o i' PERMIT FOR GAS INSTALLATION This certifies that ........... :::� ....e,�............ has permission for gas installation in the buildings of .. "+ �...-.....� �.�.......... . at ........ , North Andover, Mass. / GAS It SPCTOR Check # 71'8 NORTq 0 Date. .41 x'- 14. - . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............................................ has permission to perform ...._,..�:..�; :-���... �-<-�!........... . plumbing in the buildings of .................. at. i,>s..,1�. �.�:-:ri- ............. North Andover, Mass. Fe4A ..... Lic. No.......... !.C7� ai. PLUM. I INSPECTOR Check # 93/ 9(, V 853:1 A 11( MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 16 -Mar -10 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 Norh Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00 Each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339$750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ APPROVALS: azzL Date /'.... /,/-..e 9 ....... TOWN OF NORTH ANDOVER r o p PERMIT FOR WIRING � a This certifies that .................`.::`.`...:` ...............{ �.:. ..................... / has permission to perform ..... .:..... :... f.................. ......................................... wiringin the building of. .........................................................: �...................... ...../.-. -.... t...:.:..........:�..... , Nort. h Andover, Mass. oe Fee :7"eO....... Lic. No .............. ........... n 7EIIC,;�DISPZ R Check Jim 9 16 2 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 1 -Dec -09 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January to March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-60010-6339 $750.00 ------------------------------------------ ------------------------------------------ APPROVALS: Date. R i ".��T:I�o TOWN OF NORTH ANDOVER °c PERMIT FOR PLUMBING,/ a This certifies that :�..'r'. �.```....t........'......... . p ,. has permission to perform .................. plumbing in the buildings of � .............. North Andover, Tee. C..... Lic. No.......... til �`� ,� •............... PLUiA0ING INSPECTOR „Check # 8 3 i 4 T• 4 Date. /:.....`...!...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thP. ... .... . has permission for gas installation in the buildings of '. `""t .�' �. �... .... / ......... at , North Andover, Mass. 0 / Fee. .... Lic. No:.......... 1.611"--e' � ......... . GAS IN�SPEGTOR Check # ?e-, 7�'/2 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January to March 4, FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-60010-6339 •----------------------------------------- ------------------------------------------ APPROVALS: DATE: 1 -Dec -09 DISTRIBUTION Amount $750.00 Date. : o // L TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies has permission for gas installation ........... in the buildi s of'.'.": ...l�^f-� ......... ......... North"Andover, Mass. Fee ..... Lic. No........... ........... V GAS iNS�CTOR Check # 69� NORTH S. S Date/. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CH This certifies that ............................ 17. has permission to perform ."-'-- �'.`.- ...... plumbing in the buildings of~` ................ ' at/4.- . ..................... North Andover, Mass. Fee�0.- 7. LiANO .......... 7-.'� ............. PILUMBING INSPECTOR Check # �1 82�8 MERRIMACK COLLEGE PA vn E&T VOUCH PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01945 CHECK STUB Quarterly Permit INFORMATION: October to December r Plumbing, FOR Gas, Plu , Electrical 9 WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 9 -Sep -09 . .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ---' has permission --p_'---- ............. r.—.. ---. wiring ~..the ................. Mass. Fee----....... _~^—_..... ....... —..Y.�.---- —...-.— [ Cheok# 7__- Q n -) P. 1 s3 MERRIMACK COLLEGE oevnnFNT VOUCHHER_ DATE: 9 -Sep -09 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01945 CHECK STUB Quarterly Permit INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $75000 DISTRIBUTION Date................ TOWN OF NORTH ANDOVER o PERMIT FOR GAS INSTALLATION This certifies that .................... has permission for gas installation,,....�l.-,!-�!-rw, .............. V, in the buildings f-`�.. at ..,North Andover, Mass. . . . . . . .. . . . . Fee P.� .... Lic. No ........... �:: � ��� �� ........... GAS IN4 � OR Check 4 Ykj-'s-7- 6— r b''q U i r MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6339 APPROVALS: DISTRIBUTION DATE: 22 -Jun -09 Amount $750.00 t Date .. . �?-. ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .................................................. - �....................... has percussion to perform ............::^ .............................................. wiring in the building of .........'�...L�-`'�` �:• ......... / ..... �-1--- . at . x -r /� <:t .^%- ``'... -ZZ............ , North 6-1111' ver, Mass. Fee?........... Lic. No .............. ............. ........ .......... � Et.eccrt�c�t. Irrsrecro ! , Check # 68'/9 y I MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6339 APPROVALS: DISTRIBUTION DATE: 22 -Jun -09 Amount $750.00 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........�..."' /I... ......= - /....... . has permission to perform .. ............. .....�.............. plumbingin the -buildings of Y .... .. at�! ............. . - ' ........ North Andover, Mass. Fee.. Lic. No.........//���- ............... PL' IM-' NG INSPECTOR Check # iA� -39- 8131 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 22 -Jun -09 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339$750.00 ------------------------------------------ -------------------- ------------------------------------------ -------------------- ------------------------------------------ -------------------- -------------------------------------------------------------- APPROVALS: Date � : �� . d......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies tha`.�'° has permission for gas installation 74 . . in the buildings -of -- �.� ..`...! , ............ at e. - .. �-:�:� r . ,� North Andover, Mass, FeeAO(.Lic. No........... ................. . GAi MPECTOR Check #�.,� 6722 N MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6339 DISTRIBUTION DATE: 25 -Feb -09 Amount $750.00 0-1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. This certifies that ........................... has permission to perform.:z ...................... plumbing in the buildings of at. . ........ North Andover, Mass. Fee�:Sn.... Lic. No .......... .. PLUMBING INSPECTOR- Check 8 0'1 E. MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 25 -Feb -09 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250:00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 Date ...........//... IV-' ....... r 01 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ........... ........... .... .. .. ...... has permission to perform ........ ... ................................................................. .. wiring in the buildingof . ....... ..................................... at .... ... ....... North Andover Mass. ......I. ...... Fee .......... ....... Lic. No . ........................... ..O ............................. ....... ...... ELEcmcAL INspEcro Check # 6 6-7 Z) 1) MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 25 -Feb -09 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 r' DISTRIBUTION ` Account No. Amount 10--6010-6339 $750.00 ----------------------------------------- -------------------- --------------------------------------- ----------------------- Ap Date/p /p�. �4,o TOWN OF NORTH ANDOVER ,- PERMIT FOR PLUMBING% ,SSACHUS� / This certifies that ........................ JJ e _ has permission to perform ............. plumbing in the buildings of. at ..... ............................... .North Andover, Mass. mac, r Fee'`.Lic. No.......... . -,...—............ Check It PLUMBING INSPECTOR 7953 Date. .. � ......... . j°l-ry° Flo y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .f This certifies that ...?Y.r.l:`........... has permission for gas installation" ^.-0r.... . in the buildings of �Y`�"` `` "`�".... .............. . at `�I'�` �/ '�'`'.. .... . , North Andover, Mass. Fee. .... Lic. No........... GAS INSPE Check # 'W 70-L 6661 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January 2009 to March 2009 FOR Gas,Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 ------------------------------------------ APPROVALS: DATE: 3 -Dec -08 Amount $750.00 ------------------------------------------ Date.. / .. n. Y ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................. has permission to perform wiring in the building of ............ .................. at....... .ela ...... N rh Andover, dover, Mass. ........ LicNo .............. ....... �" ELECTRICAL INSPE Check# 8 5.:)7 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB _Quarterly Permit INFORMATION: January 2009 to March 2009 FOR Gas,Plumbing, Electrical WHAT: $250.00/each f i y TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 3 -Dec -08 Account No. Amount a 10-6010-6339 ,_________$750 00 ______________________ - ------------------------------------------ ---------------------------------------- R------------------------------------------ --------------------------------------- - ------------------------------------------ ----------------------------------------- APPROVALS: NORTp o� "c ' FO 9 •. ,SSACMUSE� i ! /- ITS s i TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... ...... ...... r. ....... . has permission to perform'-�```!i . plumbing in the aildings of ............ �✓.:�. . at . ....... :........ . .................. North Andover, Mass. N Fee. .... Lic. No.......... .............. . PLUMB NG INSPECTOR Check # 7838 Date ..... '`,7 . ... . 3= TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....^j `....... Zli.. ,..... . r..:- has permission for gas in the buildings o ...........f ......�.� ......... at .... ......... , North Andover, Mass, Fee--,".4,-� ... Lic. No..................... . \'-G , PECTOR p � Check # ~ e �- 652> MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: Qtober to December FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 2 -Sep -08 Account No. Amount 10-6010-6339$750.00 ------------------------------------------ -------------------- ------------------------------------------ -------------------- ------------------------------------------ -------------------- -------------------------------------------------------------- APPROVALS: MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 2 -Sep -08 PAY TO: Town of North Andover 1600 osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: Qtober to December FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 APPROVALS: Date .. ......... ".r./q .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING e .. ........... This certifies that ........ . . ... ....................... has permission to perform --r-- ............................ wiring in the buildingof ......................................................... . ................. ...................................... .North Udover, Mass. Fee-4,0-0!:%�. Lic. No . .............ftl�� -oo ELECT] Check # M= R MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: 01ober to December FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 APPROVALS: 4—` DATE: 2 -Sep -08 E Amount $750.00 ------------------------------------------ AN Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ` .. .................�. ... ......... . flu-�+//_j has permission to perform;.�.�.�--:-�^-. ::........ . plumbing in the buildings of .... .�. at .`!L? �.:..< t-��.- ..... , North 'Andover Mass. i Fe..... Lic. No.......... ..:.,.-!.... ....... PIUMBIN�r N� TOR Check .7 �';G/�G '� / 7684 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April - June 41 FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 17 -Mar -08 Date.. ....... NORTH ' TOWN OF NO ANDOVER PERMIT FOR GAS INSTALLATION This certifies that -� .' ...... '. . has permission for gas installation in the buildings f ......"� ..✓ ..... . at 3i�S �..!�-�-!� ,� , North And er, Mass. Fee..'— . Lic. No...........: .. -C �% ... . . (f rryy GAS INSPECT(3A Check # 6372 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April - June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 17 -Mar -08 Aj Date �:-�" ...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................... ; ....... I .............. has permission to perform,, ,.......... . ................................................. wiring in the building of 2- ...... North Andover Mass. Fee -6-6 ..of Lic. No .............. .............. .. .. . -EE. rRjCA.L SPECTO Check# %Itl, RZ An � 44 J MERRIMACK COLLEGE 44 PAYMENT VOUCHER y DATE: 17 -Mar -08 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April - June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION 1 +�. o• t,�.o ��� tia o ,,Date ............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .......` ..... .......... .. fY has permission to perform ................. plumbing in the buildings of .... `.......`."...�`'r�'~.e-.:.. . at .. '° .......... .. , .. , North Andover, Mass. Fee ......... Lic. No.. . ...... . PLIf`MBl G INSPECTOR Check # 7640 MERRII!l ACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January - March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ APPROVALS: bl�) 6..4L DATE: 8 -Jan -08 Amount $750.00 Oft Date. /1 !' la........ . TOWN OF NORTH ANDOVER i D • PERMIT FOR GAS INSTALLATION This certifies that .? ` "` `` "` `. ` 1....' has permission for gas installations-.�-- -e-: '*.".Zii�... .� - .... . in the buildingsof. ......... at ....... North Andover, Mass. Fee .. r .... Lic. No........... i O :.. ......... . ..`. GAS INSPECTOR Check # 6307 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 8 -Jan -08 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January -March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 APPROVALS: :'o Date'..........e ......... ......... ......... kORTFJ 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... L�... .... '1-4 . .................................... 1�� .......................... has permission to perform ................................. _cx ............................. wiring in the building....... ............ ...✓. ........... ............ ...... �. North Andover, Mass. Fee .:�-5p ............ Lic. No .............. ........... ELECTRICAL Check # 7977 -0 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 8 -Jan -08 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: January - March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 APPROVALS: Date ...�' . 0.7........ o� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION c ✓�� q9 SA C 14USEt This certifies that ................. �% ..... y . .... . has permission for gas installation- .. . .......... in the buildings of ......................... �!'.... at ...... - North Andover, Mass. Feed:•... Lic. No........... �!.......... ,_. ... GAS INP E TOR Check # 6143 NORTq O 9 , r. ° •�'� 49 ,SgACMUSE� r Date ..9. f 9 07 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform .............. plumbing in the b„uildings of .. ....... at . `-3? t ..... North Andover, ass. Fee`�4 . ... Lic. No.......... . j :...... .. ... (f PLUM- NCsyINSPECT R Check # \\ 7500 MERRIMACK COLLEGE PAYM NT VOUCHER DATE: 4 -Sep -07 PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover,MA 01845 CHECK STUB Quarterly Permit INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMENT: $750.00 L v DISTRIBUTION Account No. Amount $750.00 10-6010-6339 ------------------------------------------- _______ -------------------------------------------------- -------------------------------------------------- ----------- ------------------------------------------------- -------------------------------------- Date... J� t 1? ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION J This certifies that ..`.7?- :gin* �•.-.,. .-�..t`�-!...l•� ._-r' �-� .,.• has permission for gas installation, '-'.'-' ! ;• in the buildings of at . ;.1;'.. w..: �.�..,, �-e .. , North Andover, Mass. Fee n.... Lic. No..f .........;�,. a,yy�.�L,......... . C/ GAS INS 6& Check # i. zr , / J 6033 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 12 -Jun -07 PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA 01845 CHECK STUB Quaterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ------------------------------------------ ---------------------------- ------------------------------------------ ---------------------------- ---------------------------------------------------------------------- APPROVALS: A' NORTN FO p V r � r i r • o • r SSAOMUS� Date.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... ... . r has permission to perform ,:-T:.�--�'.a.� :.!�. --- . . ... . plumbing in the buildings .... . at ..!�,'�.' ..!'.� c,...,�.. !a<-... si,`'North Andover, Mass. Fee:l,,�� . .. Lic. No.........� ..� ..... � . ............... . PLf.�M�ING INSPECTOR Check # /// � L� 741 2 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 12 -Jun -07 PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA 01845 CHECK STUB Quaterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------ ------------------------------------------ •----------------------------------------- ------------------------------------------ APPROVALS:�—� Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.... u..c'i- :�.:.. .r --*�- ............. has permission to perform....:,... �.--:�.��. Via' ....:f ^.. .................... wiring in the building of .......................................�.........�.......... �.a��.... at ..... ?!� f7'-- t-� -�a, ? ..• -W� .......... , North'An�drovvver, Mass. Fee ' ........ Lic. No. .......................... 1.� �..:......... ELECTRICAL INSPECTdR Check # 70'1 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA 01845 CHECK STUB Quaterly Permit INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00/each F" DATE: 12 -Jun -07 r TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------------------------------------------------ APPROVALS: &I Date ... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. ............... has permission to perform ...... ................................ .............. .... .. ..... wiring in the buil g of ...... . ................. at lr� North C�, Mass. .... Lic. No...t.2. W.el(..4V. . . . . . 11.4 /7& ... ELECTRICAL I R Check # 7654 _A MERRIMACK COLLEGE P.4 YMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street - Suite 36-2 North Andover,MA 01845 CHECK STUB Quarterly Permit INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMENT: $750.00 Account No. 10-6010-6339 -------------------------------------------------- -------------------------------------------------' -------------------------------------------------- DATE: 4 -Sep -07 Amount $750.00 -------------------------------------------------- -------------------------------------------------- ------------------------------------------------- E� Date .. �.. f '.7....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............`.....................................:- J ............... ..:.. has permission to perform ....... wiring in the building of........ `' � ......... A at ?�`-S-R:........................... �� ...... , North And ver, Mass. Fee. Lic. No, .............. *-^.'.....1!ytu,�. J............ ELECTRICAL INSPECTOR Check # /,,272< -7 0% MERRIMACK COLLEGE ue v 1EhI VOLLGHEB PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMENT: $750.00 Account No. 10-6010-6339 ---------- ___. -------------------------- ---------------------------------- ------------------------------------ ---------------------------------------------- APPROVALS: 7zv7 DATE:. 5 -Mar -07 Amount $750.00 .----------------------------------i------------- ---------------------------------------------- •--------------------------------------------- U '00 Date - -. I ...'_'? .... /2. . / I. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. 'A ................ �'0_. This certifies that has permission to perform plumbing in the buildings of -77.-....� . . . . . . . . . . . . at-; North Andover, Mass. Fee,-.-.§�..... Lic. No......... ............... PLUMBING INSPECTOR Check # 77�'j ?i MERR/MACK COLLEGE cd YMFNT VOLL�IEB DATE:. 5 -Mar -07 PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMENT: $750.00 Account No. 10-6010-6339 ---------- ---, -------------------------- ----------------------------------------------- ---------------------------------------------- Amount $750.00 ------------------------------i •----------------------------------------------L-- w TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION • 1 This certifies that ..... ........ I. . . has permission for gas installation c�—� in the buildings of at �. `�? . ......... 1.... Z `' . !� ... , North Andov"ass. Fee'?G.. Lic. No........... �' ��� ....... GAS INSPECTOR' Check #__'� 5927 MERR/MACK COLLEGE ve v 60 f VOIULHEB PAY TO: Town of North Andover 1600 Osgood Street . Suite 36-2 North Andover, MA 01845 CHECK STUB Quarterly Permit INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMENT: $750.00 Account No. 10-6010-6339 ------------------------ -------------------------- --------------------------------------------------- ---------------------------------------------- ... /CJI/���►'�.� DATE:. 5 -Mar -07 Amount $750.00 •----------------------------------i- Date/ x�� -D (�...... °:<``° '• "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING _ . :. ": This certifies that............................................................. , r .G -�,. has permission to perform :.......:........................:..:............:..r....................... wiring in the building: of at ...... I ...........�.��..c. ::. �h c 'v.... North Mdov�Mass. Fee..................... Lic.No.. ........ :..........,....... ELECTRICAL INSPECTOR Check #�9 // 7114 Q a� O 'a Q' L O z 0 c 0 F— O Q IL LO o O N Q O > O O rn� � c OQ o. -C 0 CD 2 CU cv:3a c d cu m Z �. O Y Q v 20 U LL z V% U U O W c U ca E w d o No co N 0 � 0Q L_ /, Date . . . ..... ... . �w ,eye O TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...... Y...`......`. .. .....C.... has permission for gas installatio`.f. . in the buildings of........ ..... ....:�-�...:�- at . "'S .''" , North Andover, Mass. Fee -r ........ Lic. No........... ,. ................. GAS INSPECTOR Check 534 W C) W J J 0. V Oct LijV W z (D O C Q L 0 z 0 C 3 O H 0 H Q a LO 00 � O N Q b � 0 CD O > 0 0 rn� �Q O L O (p O Z ,rNr L E m am 0 -CD O C 7 d 7 m Z N H Y Q w 20 V LL z W C U co E 0) do O (0 LO 0~ IL 2 t� W C) W J J V V cc fi4 a� O v c Q t 0 z O 3� O F- 6 F- } Q IL 10 It OD �o 22 U ` O > OO v Oa O L O (p O Z U. z Date.......... ..�� ...... 04:� ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................ ................................................. has permission to perform ;V ..................... wiring in the building of ........ ................ ............. at.2 ............... .............. . North Andover, Mass. / - ) , � Fee.:e—� C .......... Lic. No . ............. ....... ........................................................ ELECTRICAL INSPECT6R' Check # 6 S.) 7 0 Date.............. .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ : .......... ........... .. 1� ........... ................................... 74— has permission to perform ..........................'..':.t..:...... i4.1 ................................. wiring in the building of .. . . ......... I .............. I ........................... ;-<. ..... 71 ............. at .................. ; ...................... I ..... . ................... .North Andbver, Mass. ..... I............ Lic. No .............. ......I........ ..........` ........ ................ ELECTRICALINSPECTOR ti Check # 6970 14ORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION SAC HU This certifies that .......6, ........................ has permission for gas installation ..-J, --;, - ............... •. in the buildings of-., .. ............. at.North Andover, Mass. ............ Fee—) Lic. No..' ........ GAS INSPE?71 R Check '0741 0 PERMIT FOR PLUMBING SACHUS This certifies that ....... ......................... ............ has permission to perform ... ...... plumbing in the buildings of ............................... at. . North Andover, Mass. Fee- ..... Lic. No .......... .......... -11�, ............ PLUMBING INSPECTOR Check # fi 7 i DATE: 20 -Sep -06 50,00 ------------------ y---------------------------- ---------------------------- Date �a. �..... . . TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SACMUS� .� This certifies that ., has permission to perform 4 ....--f%-..' ! ..'' • • • • • • • plumbing in the buildings of .......... .'..-�:�'%•f':...- at .. `S�tis��-sr? �-' �. a..? ... , North Andover Mass. _ 7 Fe X)..... Lic. No......... .� ...... ................ . PLUMBING INSPECTOR Check # ( %tib �11 72.2? Date............... ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................. ........................ ........................ has permission to perform ........t......'........:.. . ............. 1 ................................. wiring in the building of................................ .................. .......... at ....... ( ............ ............... ; ............................................. .North Andover, Mass. Fee.-...�! ............ Lie. No .............. ................. ............................ W ................ ELECTRICAL INSPECT61k Check # 9 Z- 0 V ••••oL TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that .... ................ -. -0 ....... I.- � �' has permission for gas installation ....................... ........... in the buildings of,.- ...... . .. at .............. North Andover, Mass. Fee. Q Lic. No..r......... ............ GAS INSPECTOR -� 2.-) -9 Check# � -, J741 0 PERMIT FOR PLUMBING SACHUS This certifies that ..... ....................... 1-t ............ has permission to perform ... t .......... .... .. plumbing in the buildings of .............................. at. . North Andover, Mass. ..... Lie. No .......... ................... PLUMBING INSPECTOR Check # DATE- ?n-spn-M 50.00 ---------------------------- ---------------------------- Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................. r............. 4 .................................................. Z. has permission to perform .......:. �:.........<.......:.f........:..:.........:...'................... wiring in the buildingof ....:...'..... ".......................!.;.................................. '-.. at .........r ............... ....... ..........t :..'............... , North Andover, r Fee--..... :............ Lic. No.............. ...................................... .... ........... ...... ... ELECi•RICAL INS . . ..... .... PECTOR Check # X970 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....................... has permission for gas installation ..'?? ^ •" in the buildings of ... •'. •' `• �� - • • • • • • • • . at .... . • . • •_•'�`'`. �''. ? : • •� �• • • , North Andover, ME Fee.} :a :.. Lic. No..f ......... ,•.:.i -; r..% ..... . ' GAS INSPEPfiOR Check # 3741 ° . p PERMIT FOR PLUMBING ,SSACMUS� DATE- ?0_.an_0A 7'.c .C.r l;9- '.I This certifies that ............ . has permission to perform ............. . . r<<--. • ; plumbing in the buildings of .................. < .............. at. ... <... - �= ���'':.. '/. ... , North Andover, Mass. Fee..:'- .....Lic. No .......... ............... !:............ PLUMBING INSPECTOR Check # 7 1 > 'i Date. TOWN OF NORTH ANDOVER PERMIT FOR GASZfNSTALLATION Io This certifies that ................................. has permission for gas installation ........... in the buildings of.---�- �-. ........... at...�-'��?-'�.......... North Andover, Mass. Fee -.;& I .... Lic . No........... GAS INSPE5TOR Check # .5-29&9 NORTH 0 44A, * o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACHUS- This certifies that................. ... 7 .......... has permission to perform_.,.-.!-�-�.......... ..... plumbing in the buildings of ................... . at 12/0 ....... North Andow..., Mass. Fee..... Lic. No.......... ....... ............ PLUMBING INSPECTOR Check # 7131 4 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street Suite 36-2 North Andover, MA OL845 CHECK STUB Quarterly Permits INFORMATION: October - December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10-6010-6339 APPROVALS: DISTRIBUTION DATE: 20 -Sep -06 Amount $750.00 _w Date........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....Ask/ n,.. ¢'n7c...,, 190 L ,�^ f fid 77,,26' c2' has permission to perform ....n...�....................................................................... wiring in the building of ..../' ......................................................... : at 31.5' /!/fLn. ........ . North Andover Mass. ..... ...................................... Fee l Z.S.. p�. Lic. No. � 70 3/4...........�� .............................� ....... ELECTRICAL INSPECTOR Check # � 7�7� 6P?� 7 THEC0AD10JVVE4LTH0FM4MCHUSEM /Office Use only 7P1'J - DBPAREVTOFPUBLICSAFVY Permit No. l9U ce BOARD OF FIRE PREYFrV170NREGa4170NS 527 CV1R 12-M Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR I2:00 /- (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date fl OU/ Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) U yjIr2m, Owner or Tenant tar l ' U e Owner's Address /-5— c4o/ ' Y, Is this permit in conjunction with a building permit: Yes m No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amp` / _Volts Overhead 0 Underground Q No. of Meters —� New Service ....... . Amps / Volts --_ Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures g Swimming Pool Above Below Generators KVA KVA andEl round No. of Receptacle Outlets No. of Oil Burners. r No. of Emergency Lighting Battery Units No. of Switch Outlets z No. of Gas Burners a No. of Ranges No. of Air Cond. Total FIRE ALARMS No. ofZones No. of Disposals No. of Heat Tons Total Total No. of Detection and Pumps No. of DishwashersSpace Area Heating Tons KW KW Initiating Devices No. of Sounding Devices No. of Self Contained No. of Dryers Heating Devices KW Detection/Sounding Devices Local Municipal ID Connections Other No. of Water Heaters KW No. of No. of Si s No. Hydro Massage Tubs No. of Motors Bailasis Total HP } OTHER A ft=a=QMrdgl& Rastt "1Dthem maTv sdNbwd uq&GWg1al Lam Iha%eaaaltLiabtldyh rV=Po ytnchjfitgaMpkt Q � i ES Ea� NO Iha%esub nodvabdP=fofSMMIDtkeOMM YES If}mha%edwdWYESspbmir*thetypecf011l a bydtg� apptopria�bmc INSURANCE �I30ND OTIIER (PfeiSeSpadfY)� PCt C'C7l�I ol WC&tosht 4 ,. Signed MJM" e Rngties ofpajt . FIRMNAME %�f'exk1 �l'1�,,�/✓ /��. E*afimD*i �C>� Fst makdVahiedEkit talk $ Rao Final LimnseNb. LimnseNo Adcesc l� c���f>7` Sf AhTe1XbL OWNER'S INSLIRANCEWAIVFR;lam awazethaKtheL tioesnothaf+etheirstaatreco�a trOsst> ariaiegttivalet>t�m#udbyNbmd Cmnd Laws rdfr><ttnrysg�thaeonlfasptsappSonQ thistegtr� (Please check one) Owner Agent a Telephone No. ��...A PERMIT FEE $ L(91-4%iu) TKE"t/c 14 ��— -.1 i Date .7. 3. l? .� ..... , i i ,40RTF1 °f _to TOWN OF NORTH ANDOVER O D - PERMIT FOR GAS INSTALLATION This certifies that . ,h%lt �./+!t��,�!�.1.. %. ��� ............. has permission for gas installation ....!l�.,l�, . �% ............ in the buildings of ...... Y.14W.. `'r....... .............. . at a ............ North Andover, Mass. r-.: Fee. 1.�... Lic. No........... .......... ..... ,,GAS INSPECTO �, Check # s-%r,A71 A MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: June to September FOR Gas, Plumbing, Electrical WHAT: $250/each TOTAL PAYMEh Account No. 10-6010-6339 APPROVALS: $750.00 DISTRIBUTION DATE: 27 -Jun -06 Amount $750.00 ----------------------------------------- Date Y;/-11 /.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .../7 ,1A. ... • .. . has permission to perform .... ?. f. • , ............ • • • • • • plumbing in the buildings of .....` .��..�a. •-:<. • • • • • ............ • at ... ! .j.`. . • • • • • ...... • • .. North Andover, Mass. Fee Lic. No .......... ........ I ...... vr^..t: .,...... PLUMBING INSPECTOR Check .7 > L. 3 '- 70'16 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 27 -Jun -06 PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits / INFORMATION: June to September FOR Gas, Plumbing, Electrical WHAT: $250/each TOTAL PAYMEN Account No. 10-6010-6339 APPROVALS: $750.00 DISTRIBUTION Amount --------- $750 -- ----- 410 Date ..4-- . ................ .( TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... . ..... .............. has permission to perform ........ 11,1A ................................................... wiring in the building of .......... .................................................... at ..... ........ ............................ . North Andover, Mass. Fee...1 .-.. ) ...... U ......... Lic. No .............. ............... Pzi-7 ............................ ELECTRICAL INSPECTOR Check # U MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 1600 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: June to September FOR Gas, Plumbing, Electrical WHAT: $250/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 27 -Jun -06 Account No. Amount 10.6010-6339 ------------------------ $750.00 APPROVALS: A Date . *-3 . /� . O 4. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �SSACMUSE` /, This certifies that ......�..�................... . has permission to performr.- -'� �?'f- . f plumbing in the buildings of ....... North North Andover, Mass. Fee; .... Lic. No.......... �._F..,. r_�1 �!�............. PLUMBINGINSPECTOR Check # 5-3 6. G d i; 1+ -MERRIMACK COLLEGE PAYMENT VOUCHER -- - DATE: 7 -Mar -06 PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Am©Why 10-6010-6339 $750.00 -----------------------------------------, .------- APPROVALS: 471 p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION r This certifies that--.--. ',,/ e... . has permission for gas installation—.4.... in the buildings of `-3....... `'''.'?�.......... at . 3 ......'"' `6''''�'-�...° .' .. , �%7�ndover, Mass. Fee.? . Lic. No............. C~-GAS INSPECTOR G� Check # 54.86 I MERRIMACK COLLEGE PAYMENT VO QC DATE: 7 -Mar -06 PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June FOR as, Plumbing, Electrical WHAT: $250.00/each TOTAL PAyMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ----------------------------------------- ------ APPROVALS: IP Date -./ e . ........ I TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. . .......... ... .......................... ............ ......... ... has permission to perform ----';-�." ....................... ........ wiring in the building of ...... 4 .............. ...... IV ................ ..................... ,North Andover, Mass. F ................... Lic. No .............. ........... . .... ..... c..... ELECTRICAL INSPECTOR Check # eq t"" K, ,I J MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 7 -Mar -06 PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June r - FOR Gas; Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ------------------------------------------ APPROVALS: P Date;!. ! .. . TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING This certifies that has permission to perform ....,. ! `.............. plumbing in the buildings of ...... .......... at .. 3.1.s . .. ...... . , North Andover, Mass. Fee .2.> 0.l ... Lic. No .......... ...... L---.. ...... /PLUMBING INSP CTOR Check # /C I 674. MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 12 -Dec -05 PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas, Plumbing, Electrical WHAT: $250.00/enrh TOTAL PAYMEN $750.00 Account No. 10-6010-6339 ----------------------------------------- ---------- ------------ 7 ------------------ ------------------------------------------ APPROVALS: --------------------------------------------------=------------------------------- ----------------------------------------- APPROVALS: CJ_ /1 --rs DISTRIBUTION Amount $750.00 •------------------- Date ...,! `/ 4 .6....... . 3�pya «ao ,eye pL TOWN OF NORTH ANDOVER FO F • PERMIT FOR GAS INSTALLATION This certifies that .. W..X-'r'o !!..... !......- � �Y 5. has permission for gas installation .... ........... in the buildings of ............................. '?at .. XJ. - <fF. A � �.... C- ........ , North Andover, Mass. Fee.?. Lic. No........... .. , ... z-. / GAS INSPECTOR Check #) / /- ? / 5366 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 12 -Dec -05 PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March r FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 ----------------------------------------- ------------------------------------------ ------------------------------------------ APPROVALS: Lo_ /1_ -7v- 02 Amount $750.00--- ------------------- •----------------------------------------- 6294 Date.l..`z� Irl .............. t• °`'"`° ;•� "o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that .....�.. Ali. h �. �...�`.......�::1..:`.......::.......... has permission to perform `` wiring in the building of .............. v` ............................................... at ...... 0........... �....^...� ! :...'`.............................. , North Andover, Mass. Fee �...... 6.� ...... Lic. No .............. ............ ELECTRICAL INSPECTdR(::. Check # / L ) ! MERRIMACK COLLEGE PAYMENT VOUCHER 4\ PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 APPROVALS: DATE: 12 -Dec -05 Amount $750.00 61179 Date ..7//.. > 1'r..:.�.... f NORT/{ 1 o?;,;``°„ TOWN OF NORTH ANDOVER PERMIT FOR WIRING J This certifies that / ..' `l `'t --t.................................... ......... .............. has permission to perform .........hi!.. 1--�71 t?... �..................................... wiring in the building ofi,� 6 �' '` ........................................................................ at ...... 3.../ ...). .......................... ..�.......-, .............. , North Andover, Mass. ����. l Fee.?..�Q.`........ Lic. No .............. ............... ? ,�1--:ell................... r ELECTRICAL IA:LTOR Check # l 1�1 5 ` J MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quaterly Permits INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 Account No. 10 -6010 -6339 ----------------- APPROVALS: DISTRIBUTION DATE: 9 -Sep -05 Amount $750.00 ----------------------------------------- ----------------------------------------- ----------------------------------------- ----------------------------------------- r Date. Y,%eGJ.� N OF NORTH ANDOVER PER FOR PLUMBING SSA�MUS� / p This certifies that .../10r.P tc�.,E�!. ....`. ....... P, .,,,., has permission to perform ... k1? oqx�'. !� .................... plumbing in the buildings of ........................ at. !.1...........North Andover, Mass. r Fee .�.}. v ... Lic. No .......... ........n-� PLUMBING INSPECTOR` Check # (t � ( f a 6612 r 0 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quaterly Permits INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 APPROVALS: DISTRIBUTION DATE: 9 -Sep -05 Amount $750.00 ------------------------- ------------------------- ------------------------- ------------------------- Date . 9i.. . * `.... . NORTH � ` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ..e�.a !F f: rr t. t... �. �. fr/-?........ . has permission for gas installation .... 14.': f . in the buildings of .....��! ............................. at ... .P fi f . ............ North Andover, Mass. Fee `! J . ... Lic. No........... .... 4 .{�,,. , ..... . AS INSPECTOR Check # 4 t f MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 400 Osgood Street North Andover, MA 01845 CHECK STUB Quaterly Permits INFORMATION: October to December ti A FOR Gas, Plumbing, Electrical WHAT: $250.00/each 21�1 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 DATE: 9 -Sep -05 Amount $750.00 ------------------------------------------ Date. /�!..... TOWN OF NORTH ANDOVER A i PERMIT FOR GAS INSTALLATION X" SSA�NUSE� This certifies that has permission for gas 9installation in the buil 'ng of-f1�-.. �� . ��', a'l. ,C.=�� at c- / • /•�� ' (. -� j .�.. Noah Andover; Mass. GAS INSPECTOR Check # 5'146 C-� A� - 4-3 - 0 S - Date.................................. -;"!_4 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING A U �............. ........ ........Thiscertifies that ... ... . ...I .. has permission to perform M.44Y......... ....I.....;...- ...................... wiring in/the building of ...... . ........ ............. . *..* . ............ ............... ............. North Andover, M4s. Lic. No. ............. ......... P ...... �.i .... ELECTRICAL INSPECTOR Dec)( t, 7 Date.447_�': _�J 3?0�<�, •°„•.',tioo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACNUS� This certifies that........................ has permission to perform ........ •.. , plumbing in fie buildings o .,���� . �����..�:........ •C� al�' ... .� �..... !.-... North/Andover, Mass. F,ee ! ... Lic. No..........%.f;Ml�if PLUMBING INSPECTOR) Check * ��/�j a MERRIMACK COLLEGE PAYMENT VOUCHER Town of North Andover 6/06/05 400 Osgood Street PAY TO: North Andover, N.A. 01845 CHECK STUB Quarterly Permits INFORMATION: July to September 2005 FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN- $750.00 DISTRIBUTION r Account No. Amount 10-6010-6339 $750.00 •-----------------------------------------• •------------------------------ ----------------------------------------- ------------------------------- ----------------------------------------- •------------------------------ APPROVALS: ( "/� KCEI 1 3 2005 IWN OF NO.R ANDOVER HEALTH DEPA MENT _�A N RTIy Oq •o ,•,� O 1 immalma '"SACHUSE� Date �- 2 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... .1. . - ......... has permission to perform .....kt'.? .................... plumbing in the buildings of ........................ at .. � ................ . North Andover, Mass. Fee. 2A 4.... Lic. No .......... ....... ...1,- LUM13ING INSPECTOR Check # 1-13f 6399 Date. . z �� :.`..'....... . Ilk o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.. s'. t-,.'." ..... C.`..`..l'-1. has permission for gas installation ......................... in the buildings of .... `.'... ............................ . at ... !.1:.. !`. !` .`' :. .:.......... . . North Andover, Mass. � GAS INSPECTOR Check # c1 '33 ? S L' 7 ?_ 4 3 Date...-- 7n.r TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......M f . rr fei. i 74. .7 ........... has permission to perform .... wiring in the building of ............... AY471 .... n ......................................... at ............. ;3. .... /..-.S. ........ ..... North Andover, Mass. Fee.al,l—,.V:..'. Lic. No . ...... . ... ......... ELECTRICAL INSPECTOR Check# 5v 16 1 I MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 27 Charles Street North Andover. MA 01845 CHECK STUB 2Larterly Permits INFORMATION: April to June 2005 FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION DATE: 15 -Mar -05 )0395? Amount Account No. $750.00 ---------------------- 10-6010 6339 ------------------------ --------------------------------------- NORTH P Date... !�..!.......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING °SACNUSE� __,dl, / This certifies that)/../�� /`ie.. .. has permission to perform ......�-.. .......� wiring in the building of ..... %z......... `� ....... .... /. H �� ...... at v�t/1.�! 1 .... ..�............ .jN�-orrth Andover, Mass . Fee l/.`! Lic. No .............. ..��!�`...••%..0/..(.. /2 5460 ELECTRIcALINSPECTOR Check # 5460 Date .. /.14. 1w .. . HOQTM °F ,ti° 3� TOWN OF NORTH ANDOVER O D 4 1 • PERMIT FOR GAS INSTALLATION SSAC'HUSEt 2LIll�� This certifies that .... / ,.. f . .... . has permission for gas installation . ll1� in the buildings atr�f `� .'�!�-�!.... , North Andover, Mass. , Fee..-�.a0.. 4)Lic. No...................... 0 � ........... ....GAS INSPECTOR Check # `/ S - 1 �� L/ Date....'/ 31'1. +',;:4,coi TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SS US This certifies that ........ /, . /I/.. (...... has permission to perform plumbing in the buildings of �l�-��l %.�.... ........4:.� at .1�.1A, ....... , North Andover, Mass. Fee ,--W/Ohic. No .......... ............................. . PLUMBING INSPECTOR Check # 6 26 6 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 22 -Nov -04 PAY TO: Town of North Andover 27 Charles Street North Andover, MA CHECK STUB Quarterly Permits INFORMATION: Janu !ry to March 1 FOR Gas, Plumbing, Electrical WHAT: $250.00/each r ` TOTAL PAYMEN $750.00 DISTRIBUTION - Account No. Amount 10-6010-6339 $750.00 -----------------------------------------• •----------------------------------------- -----------------------------------------• •----------------------------------------- ------------------------------------------ •----------------------------------------- APPROVALS: -"')" Date. ..!�f/?.... 1 • r NORTH ^�ti0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION S.4 USEtt This certifies thatJ)1av41--1 &-- • has permission for gas installation ��.�- .�-.. /i� .? .! .. . in the buildings of ` ��-.....!.........�-�/........... at ?�� �� ^^.! `� .......... Noi-th Andover, Mass. Fee.,,;�,q PLic' No........... .......................... GAS INSPECTOR Check # ,2VM 4 662 'Date ........ ..... ..... ..... ,IORTN, /TW�N OF NORTH ANDOVER 0 PERMIT FOR WIRING ;ACHUS This certifies that .................. ........... has permission to perform ................... wiring inthe buil ding of.10.� .. ........... at .` ................I..:` -i... .... I ...y...-.. ................... . North Andover, Mas. iFee21 .. Lic. No .............. ............................................................... ELECTRICAL INSPECTOR Check # Av� 5488 x� U/ Y at r ... .. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� 11*7 This certifies that...... .... . ................ . r - has permission to perform �:,:�—�-�-�-:�.-����:� -�.. ... plumbing int the buildings of. v ..........f .��.. Z O` at .v�� .... .... , North Andover, Mass. Fee.`J :.. Lic. No.......... ... ............ L INSPECTOR Check '# ✓ +tel 61951 N M o � o 00 M o H In I I Ln I N 00 W H i o i q� O H I N 1 I 1 M [� O I L� O I 00 I f`1 O O I U In I •• Cl) 1, I • H {/} I Olay I z x O I U o 1 WH 1 x�0 IW U to IW IJ I0 IV Cl) IY 1Q U) I� 0 1� IW � I O I O I N I \ I N I N I \ I 0) I O �I I N 1 I WUo rcj 1 E-I H kD �' I goo r>y I A�0 H o �1 I U �4 1 W 01 x o z I U o I N Lw 1 \ 0 I W� I FI g\ 3 I q rn O 0 H 1 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 14 -Sep -04 PAY TO: Town of North Andopver 27 Charles Street North Andover, MA CHECK STUB _Quarterly Permits INFORMATION: October to December FOR Gas, Plumbing, Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 .Iq ,40RT#1 o4AT.0 ,SSACMUSEt TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... .......... has permission to perform ........ / .41 ..................................................... wiring in the building of ............................................................... at ....... . .................... rq1,A4r1..LA:i...................... . North Andover, Mass. Fee. !.I. ....... Lic. No .............. ................ 1�';............................... NSP ECTOR Check # t R MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 25 -Jun -04 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount . 10-6010-6339 $750.00 ------------------------------------------------------------------------------------ APPROVALS: ,AERRINiAw e, WLLEGE Accounts Payable Dept 315 Turnpike Street acrth Andover, ''f � 0194 Date .. 7:..%� .. �! / ... TOWN OF NORTH ANDOVER ' 9 Lim'' • PERMIT FOR GAS INSTALLATION This certifies that ... ' {!? .e..�!. has permission for gas installation .............. in the buildings sof ..... .......................... at ........ , North Andover, Mass. Fee. U Lic. No........... .. � ... ..�, ....... GAS INSPECTCFf Check # 4780 8 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 25 -Jun -04 �Nbrth PAY TO: Town ofAndover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Gas, Plumbing, Electrical WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ----------------------------------------- ----------------------------------------- ------------------------------------------ •----------------------------------------- ------------------------------------------ ----------------------------------------- ----------------------------_�---�----------• •----------------------------------------- APPROVALS: MERRIMACK. COLLEGE Accounts Payable Dept. 315 Turnpike Street North Andover, MA 01845 ." Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform .... ................ plumbing in the buildings of .....f .%:,fl / .................. at ... 1. z�,, :. / !.............. . North Andover, Mass. Fee, Lic. No.......... . x. A.,. . P UMBING INSPECT03 Check # G��S f� 7 MERRIMA0CK COLLEGE PAYIVrENT VOUCHER DATE: 25 -Jun -04 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Gas, Plumbing, Electrical , WHAT: $250.00 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount , 10-6010-6339 $750.00 --------------------- -----------------------------------------• •----------------------------------------- -----------------------------------------• •----------------------------------------- -----------------------------------------• •----------------------------------------- APPROVALS: g&Ze�4L 1�ERRINIA k, jOLLEGIE Accounts l'.,.)yable Dept 315 Turnpike Street 4orth Andover, ''.fA 0184; I N Date ... ............... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SSS HIJ5E` This certifies that ................. / .... /. has permission for gas installation in the buildi' gs of .Z., �Jll Z/�1�1�f-..�!(../' l` -f' ..... . at ��:!. l N,11r�l-.2�� .:. .......... North Andover, Mass. Feev� `�U Lic. No........... .......................... GAS INSPECTOR Check # �� � x;.65,? i,l Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....:.............%.: has permission to perform !. !.:�.....:�:1..� r 1....ia........................ r% wiring in the building of ......'....:. ...................... . North Andover, Mass. at............................�:.....:............ Fee .........j: .:. Lic. No............ Check # J -� ............................................................... ELECTRICAL INSPECTOR r Date. . J -1111a. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS� This certifies that .......... .. ... .......... ..... . r , has permission to perform ......�...l... plumbing jqJbe buildings of . � at ....../ /.�/�.......... ,North Andover, Mass. Fee. -.%,� Lic. No .......... .............................. PLUMBING INSPECTOR Check 9 5521 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: Feberuary 18, 2004 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June FOR Gas, Plumbing and Electrical WHAT: $250.00/each • TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. Amount 10-6010-6339$750.00 --------------------------------------------- ------------------- --------------------------------------------- ------------------- --------------------------------------------- ------------------- ---------------------------------------------------------------- APPROVALS: I r �/w// ... p` Sao ,eye pL TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ............... ..... ...... has permission for gas installation .C..�/.1 in the buildings of .. �1 ��.> ...� :%�Ll ', 'A;Vm.. . atl./ .7 Le /%) �° 11�-�. S_ f .:.. , North Andover Mass. Fee. -'y . S ...... Lic. No.......... . Check # -QlX 1:567 .......................... GAS INSPECTOR NORTq O 9 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSCMUsc� % This certifies that has permission to perform r I plumbing in the buildings of /1/. .. .../..l/. at. 1. ILL l . �-� .. .. , North Andover, Ma s. Fee. 9...... Lie. No .......... ............................. . PLUMBING INSPECTOR Check ,N r ` 5 E 3 7 10 f (I,.- (1 0 0 Date... ...... ............. ..... I TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... /..:.:.....�........... ............... ............ . j ..... . . . ............. has permission to perform[ . ......... wiring in the building t I at ...2Z.2 ...... ............... . North Andover, Mass. Fee'-�5 .............. .Lic. No . ............. ............................................................... .......NSPECT0R ELECTRICALI Check # 4. "),10 11 14 I S UU 9�0 r MERRIMACK COLLEGE PAYMENT VOUCHER DAT.F..: 5 -Dec -03 PAY TO: Town of North Andover 27 charles Street North Andover, NMA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March FOR Gas, Plumbing & Electrical WHAT: $250.00/each 0 TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ----------------------------------------- ------------------------------------------ ----------------------------------------- •----------------------------------------- ----------------------------------------- I ------------------------------------------ APPROVALS: Date . a .. ..... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... I ....... has permission to perform .... .................. plumbing in the buildings of ...... .................. at ............ North Andover, Mass. Fee.v..—.1-1c. No .......... ............. ....... // PLUMBING INSPECTOR Check #,) 5717 1 � MERRIMACK COLLEGE L.- PAYMENT VOUCHER DATE: 3 -Sep -03 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December A< y FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339$750.00 ------------------------------------------ ------------------------------------------ ------------------------------------------ •----------------------------------------- ----------------------------------------- •----------------------------------------- -----------------------------------------..----------------------------------------- APPROVALS: Date. '...�f .. �..?..... TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that .. r'r . !........ �.:...... . !. .. .. . has permission for gas installation .............. in the buildings of ............................. at ...3 .! . �.... .� ? �.r. �� , _ North Andover, Mass. Fee. Lic. No........... ..........�............... GAS INSPECTOR Check # ' �rf�Ji MERRIMACK COLLEGE " PAYMENT VOUCHER DATE: 3 -Sep -03 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits r INFORMATION: October to December FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10-6010-6339 $750.00 ------------------------------------------ •----------------------------------------- ----------------------------------------- •----------------------------------------- -----------------------------------------• •----------------------------------------- -----------------------------------------. -------------- ; _ �ae:�2„ a NORTH 44, �i7+O••no .�'�qh SSAOMUS� Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......... has permission to perform .... ,%.!!�. �................... . plumbing in the buildings of ... r. x.,- �e !f e-l.� ! .. :- at ... 3 /� ../. .,n � /1. � /? ............ . , North Andover, Mass. Lic. No .......... ........ --...... . ,PLUMBING INSPECTOR Check # 1 ` 5656 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 27 Charles Street North Andover, Ma 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Ga, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN Account No. 10-6010-6339 APPROVALS: $750.00 DISTRIBUTION ------------------ ------------------ ------------------ Amount ----------------------------------------------------- DATE: 24 -Jun -03 Amount $750.00 Date . 7.- J . c- .1........ . O 3? '' TOWN OF NORTH ANDOVER F� p PERMIT FOR GAS INSTALLATION y This certifies that ...�/.r����.rt,�:.�!.r�— y. . has permission for gas installation ............ in the buildings of .. �:..��:. . �.-F. :............. . at ............... North Andover, Mass. Fee.:.? v." . Lic. No........... ... k, .. .. ....... 1aS INSPECTOR Check # i G 1 % `i 44 A MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 24 -Jun -03 PAY TO: Town of North Andover 27 Charles Street North Andover, Ma 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Ga, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. Amount 10.6010 6339 ------------------------ $750.00 ----------------------------------------- ----------------------------------------- ----------------------------------------- ------------------------------------------ ----------------------------------------- ----------------------------------------- •----------------------------------------- APPROVALS: Date ..7...1.:. �............ IV``° '• TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that r ................................................................................ has permission to perform .......�7,1,��r...<.:........................................ .. .... wiring ;a the building of .... ZY. e. ; F ...... K. l ............... at ... .... '.................. . North Andover, Mass. Fee . 2............ Lic. No .............. ......... f .. t ....... *T . -� ...................... ELECTRICAL INSPECTOR Check # 1 1 �r6J MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 24 -Jun -03 PAY TO: Town of North Andover 27 Charles Street North Andover, Ma 01845 CHECK STUB Quarterly Permits INFORMATION: July to September A 5 r 1 FOR Ga, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Lj /�✓ Account No. Amount 10-6010-6339 $750.00 -------------------------------- •----------------------------------------- APPROVALS: 111-270 Date ... IAI,�- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..... fd ( . a"- X t . ....... .........../o.r............... re.�.c "- has permission to perform .......... ...... /- ............... oil / ......... wiring in the building of ...... ................................................. 7.......... at .... ...,,orthAndover Aass. FeEqU ....... !0 Lic. No. ...... Check # �), 640 / ELEcrmcALTGER — A Date./2 d. .?..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .111/.l,41� /1! /!'. `........... has permission for gas installation ............. in the buildings of .......................... at / .... !? 6 /l ...... ..... , North Andover, Mass. Fee �J. .... Lic. No.. r ... +� ...... ....... GRAS INSPECTOR Check # C t 1 4257 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....../......... has permission to perform .....�!:!!`1!!.. `................ . plumbing in the buildings of .....1 % ! .................. at ... ...... North Andover, Mass. Fee. Lie. No..L. L.. �.. .......... ..... PLUMBING INSPECTOR Check # ?6 l � c i/ 547u rA` I MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: January to March 2003 FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION L""x DATE: Decemeber 10, 2002 Account No. Amount 10-6010-6339 $750.00 ----------------------------------------- •----------------------------------------- -----------------------------------------•----------------------------------------- ; ----------------------------------------------------------------------------------- it Date .��...-. �. C.:.L .'...... . �..o ,e.e o TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ...ol- .,1�-/ !!............. . in the buildings of .. � ? ! H�� ,? ,� ...�� . `.. r.�.... . at .. ! .' ! : `%" .'..�,............. . North Andover, Mass. Fee ?. �/ ... Lic. No........... .......1`r.....�.. ^.... . GAS INSPECTOR Check # 4132 r -- s MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 1 -Oct -02 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits I, INFORMATION: October to December FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 APPROVALS: Amount $750.00 _________ Date .(��-7 lC TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . <r.< •••/•"'••••••••• has permission to perform ........11?A "• • f plumbing in the buildings of ...!!.''. !./t!?�... �'• . ..... .... • . at .. 7i )..... 7.� .� 4-.'. f ."5 . • • • • • • • , North Andover, Mass. r` Fee !&� .-� (` Lic. No .......... ......... �, ..... ,.��. r, ..... PLUMBING INSPECTOR Check # 5372 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 1 -Oct -02 PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December r FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN $750.00 DISTRIBUTION Account No. 10-6010-6339 APPROVALS: Amount $750.00 ------------------- 1~ 1.000 , Date.. ......................... NORT1, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... d.. `7 .... �.... � ... .........l ..:.......... has permission to perform ......... 4. -7...loll...... �........................................ wiring in the building of .........dam' . 'f'!`! .!. N.. ` ............................................. at .........IL?..... ....1 :.......................... , North Andover, Mass. Fee.. LECTRICALINSPECCOR Check # 1 1 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December FOR Gas, Plumbing and Electrical WHAT: $250.00/each TOTAL PAYMEN Account No. 10-6010-6339 APPROVALS: $750.00 DISTRIBUTION DATE: 1 -Oct -02 Amount $750.00 I s �� r •...\ F Date.. . % -! ?.`., z—. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that .......... `/ - ........ . has permission to perform ........ . plumbing in the buildings ofC -.. . at .. X16 ......... North Andover, Mass. Fee t58 . . Lic. No. !. '� ,/,t �.. ............. . i ��PLM�42NSPECTOR Check # 5291 Date.....�......��.1..P-- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... M..(2IL.! tt. `..`.. f `.........(. �?..(.'. P c, 'p. .... has permission to perform ............1 P.!.'z.f........ `'.O/ . ................. ws;4ing in the building of ................... ................. :/..f%. �f�f'194� h.........�� c 3�S C -i G 1 r. ►�4/ �f �t" orth Andover, s. atK....°........................................................ Fee-/ �'�" Lic. No....`!�. �. r . I �1 ELECTRICAL INSPECTO Check # ✓ 5'7 S/ Date......' .............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............... has permission for gas installation ............................... in the buildings of .... .................. . at .................................... North Andover, Mass. Fee. % ......... Lic. No. - - ; ............. GAS✓INSPECTOR Check 4. 71 MERRIMACKCOLLEGE PAYMENT VOUCHER DATE: 19 -Jun -02 PAY T0: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECKSTUB Quarterly Permits INFORMATION: July to September _ FOR Repairs and Maintenance WHAT: Plumbing, Electrical and Gas @$250.00 each TOTAL PAYMENT: $750.00 M DISTRIBUTION ' ; ccount No. 10-6010 ------------------------------ ----------------------------- ------------------------------ APPROVALS: Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- 37 - _ Date .................................. t"`° ;•'"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING • a This certifies that ..... e'.... t.... 1- ..................... has permission to perform ...... / ..:.............................................................. wiring in the building of ...........1.......................................................... at .............. /..... \! ........ , North Andover, Mass. Fee... ..2 ... ........ Lic. No .............. .................... .. 1'�� : �:! ......... ELECTRICAL INSPECTOR Check # MERRIMACK COLLEGE PA YMENT VOUCHER PAY T0: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June FOR Repairs and Maintenance WHAT: Plumbing, Electrical and Gas @ $250.00 each TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 10-6010 ------------------------------ ------------------------------ ------------------------ APPROVALS: DATE: 2 -Apr -02 Amount -------$750 00--------------- -------------------------------------------------- ----------------------------- - Date..` ..:..... (.. *.\... . NO RT1y of '` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....�..:: has permission for gas installation ... 11. ........... in the buildings of ......`? . �. ........................... . at.. !. ...!�. !'. ! !...... f..... , North Andover, Mass, Fee.).� V :.. Lic. No........... GAS INSPECTOR Check # J MERRIMACK COLLEGE PAYMENT VOUCHER l DATE: 2 -Apr -02 PAY T0: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June IV Y FOR Repairs and Maintenance WHAT: Plumbing, Electrical and Gas @ $250.00 each TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 10-6010 ------------------------------ ------------------------------ ------------------------------ APPROVALS: Amount -------$Z§-0-00 ----------------------------- ----------------------------- ----------------------------- APPROVALS: 750 00 Date..-//-./'.-.-. `..l TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform ..... �.7 i71 plumbing in the buildings of ... ,-I. .(./ ............ at ....3.! .�. �. �: y:� .. �.�... `1 ...... , North Andover, Mass. Fee .. ?. ) .L� .. Lic. No .......... ......... ". PLUMBING INSPECTOR Check # D ° ) 5 r 520 to MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 2 -Apr -02 i PAY T0: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECKSTUB Quarterly Permits INFORMATION: April to June FOR Repairs and Maintenance WHAT: Plumbing, Electrical and Gas @ $250.00 each TOTAL PAYMENT: $750.00 Account No. 10 -6010 ------------------------------ APPROVALS: DISTRIBUTION Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- 3557 1... " .. LDate ....... ............. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......r��J///.�� "� r l / ........................................ has permission to perform /� wiring in the building of.......'� at .......3.x.1.. ......`1....�..l.....:.,.................................. . North Andover, Mass. Fee ..2.? ............ Lic. No....` ........ ....................�........ t.� :.. � � ......... ELECrRICALINSPECTOR Check # Date. ./ ................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �- /'I / x- / /' ,, , 5 This certifies that .. ...................... 1/1 f ....... I ........... has permission for gas installation .. . ................. in the buildings of ... at ...'.....K". . . I .................. North Andover, Mass. Fee. Lic. No........... .......................... GAS INSPECTOR Check #- /f ( e ..- At NOR,rh O F s � ••"s SACIIUSE� Date. 1 } L TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..%? /�/.�!." : ". �` •� �`.>.... • • . • • • • . . has permission to perform ............................ plumbing in the buildings of .. %? at ... ,lL . .� k ................... . North Andover, Mass. Fee ..). $ v - . Lic. No......... . Check # % (I C c 5 5121 ......;/PLUMS .. .. ..// ING INSPECTOR NId- MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North AndnvPr 27 Charles Street North Andover, MA 01845 CHECKSTUB Quarterly Permits INFORMATION: January to March DATE: January 14,2002 FOR Repairs and Maintenance WHAT: Plumbing, Electrical and Gas $250.00/each TOTAL PAYMENT: $750.00 DISTRIBUTION account No. 10_6010____, ------------------------------ APPROVALS: El Amount $750.00 ----------------------------- -----=----------------------- ----------------------------- ----------------------------- N° 3 J J 7 Date...l.4/.J.......�//')A�. 1116\TOWN OF NORTH ANDOVER • , • OL PERMIT FOR WIRING This certifies that ........... i i ► . ! , G, r o (/-, r -r ................................... has permission to perform ........... 0.....I......!..I.......... ..................�. wiring in the building of .............,.r..� i..l..i. E' ................................................... at .............%.L....... � !, r1. `.'�l�!.....:.>. , _ ... , North Andover, Maass Fee ..:t'd..d' Lic. No.(-.. j...� - ':: ,� .. `�....... , ELECTRICAL INSPECTOR Check # �_- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer This certifies that ... `P C� � .'..... ti1 G, , ...!.`.......... `.. u .. u K . ,�. -e has permission to perform....... �.:r .......................................................... wiring in the building of ......... f.4 �...�e `' '. f-1 S ............................................ at ....... ............. , N67-th Andover, Mass.` Fec . .-Z� v.: d`J Lic. No .................. .......................................... ELECTRICAL INSPECTOR 4b 690 Check # d� �- .- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer oDate.... .................... f NORTI� °���``° '•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,`S$Aru115� J This certifies that ... `P C� � .'..... ti1 G, , ...!.`.......... `.. u .. u K . ,�. -e has permission to perform....... �.:r .......................................................... wiring in the building of ......... f.4 �...�e `' '. f-1 S ............................................ at ....... ............. , N67-th Andover, Mass.` Fec . .-Z� v.: d`J Lic. No .................. .......................................... ELECTRICAL INSPECTOR 4b 690 Check # d� �- .- WHITE: Applicant CANARY: Building Dept. PINK: Treasurer U1 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover 27 Charles Street North Andover, MA 01845 CHECK STUB Quarterly Permits/ 4+.o INFORMATION: Plulmbing, Electrical and Gas $250.00/ea. FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ DATE: 28 -Jun -01 Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- G TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING kill SACNUS� This certifies that . Z has permission to perform .. .� ... ��!t� .............. • • • • plumbing in the buildings of ...,.' ................. at .... • :. • • • • • • • , North Andover, Mass. Fee ..� > v ..Lie. No.......... ......... ...... PLUMBING INSPECTOR Check # i WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date ... e.......... `....... . W 0 ° TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation :....... `...... . in the buildings of .......................................... at ......... ....... North Andover, Mass. Feel ?. ✓ ..- Lic. No........... ........ ? _ ..:r. -........ . GASINSPECTOR/' Check # 36 C MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover Com ent 146 -Main -Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June 2001 DATE: 29 -Mar -01 FOR Repairs and Maintenance paermits WHAT: Plumbing, Electrical and Gas $250.00/each TOTAL PAYMENT: $750.00 Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: Amount $750.00 ----------------------------- ----------------------------- ----------------------------- " Date . / .11..` : . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .i............. :. ... f .l l: < ....... has permission to perform ..... •.............. • .... • • ... piumbing in the buildings of . A..�............. .............. . i 't ... •�. / ......: r ?, .! ... . F......... , North Andover, Mass. v � % Fee:-. .... Lic. No.......... .............. PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover Community Development and Servics 146 Main Street North Andover, Ma 01845 CHECK STUB Quaterly Permits INFORMATION: January. to March 2001 FOR Repairs and Maintenance Permits • WHAT: Plumbing, Electrical and Gas $250.00/per TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: Amount DATE: 8 -Jan -01 -------$750_00--------------- ----------------------------- ----------------------------- ----------------------------- Date..YZ....;........`... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING G � " n This certifies that ....., ..../ '- :� <- ...................................... has permission to perform ........... �:. . E ` �. �.`...... f .................................... wiring in the building of' at .........:... `, North Andover, Mass. Fee.......... ` ....... Lic. No .............. ............................................................... ELECTRICAL INSPECTOR Check # % ; WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACKCOLLEGE PAYMENT VOUCHER PAY T0: Town of North Andover Community Development and Servics 146 Main Street North Andover, Ma 01845 CHECK STUB Quaterly Permits INFORMATION: January to March 2001 FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00/per TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: DATE: 8 -Jan -01 Amount -------$750_00--------------- ----------------------------- ----------------------------- ----------------------------- 10 0r Date..! .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9 This certifies that ............................................ hA permission for gas installation ........................... . in -he buildings of .......................................... at .........." .......................... North Andover, Mass. Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 8 -Jan -01 PAY T0: Town of. North Andover Community Development and Servics 146 Main Street North Andover, Ma 01845 CHECK STUB Quaterly Permits INFORMATION: January. to March 1% 2001 FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00/per TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- JJvi Date....".l.r..��..... 0440RT#q TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION r This certifies that ................ has permission for gas installation ... ............ in the buildings of ..... ' /�a •rr .:-5 ........................ . at .............. . , North Andover, Mass. Fee. Lic. No........... .... ,GAS INSPECTOR WHITE: Applicant CANARY: Building De 4. PINK: Treasurer R Date........... N° .5 ",ORT:o TOWN OF NORTH ANDOVER .r ..• '• 0 �� �a PERMIT FOR PLUMBING s o� • ' a SSACNus� This certifies that .. ��':.!? l�if.!1.% • �• • ` �• . f :: �: has permission to perform .... !....... • ......... • . plumbing in the buildings of !!.'. ...�J�..� .//— / at ... X ................North Andover, Mass. U. Fee .� .). .... Lic. No .......... ................ .rv� j PLUMBING INSPECTOR Check # G t S WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00/per TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-3900 -----------------------j-`j-"----- ----------------------L1---i- APPROVALS: DATE: 1 -Jul -00 Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- Date....! ,! ......I ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that...............r.......................................................... :� ................ has permission to perform............................................................................... wiring in the building of .............. ,............XS .................................................. at.................:...:............. .............:..................... ........ , North Andover, Mass. iFee....................1 Lic. No........!................................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BATH INVOICE NO. INVOICE DATE TP GROSS DISCOUNT NET 92701 13—JAN-00 200007INV091 00257 07—JAN-0 19500.00 040c is500.00 TOTAL 1x500.00 0.00 19500.00 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 ti MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 7 -Jan -00 PAY T0: Town of North Andover Community Development and Services 146 Main Street No. Andover, MA 01,845 CHECK STUB Quarterly Permits INFORMATION: October to December January to March FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00/per. IF OT4 PAYMENT: $1,500.00 DISTRIBUTION ccount No. Amount 6010_39------------------- ----- 1,500 00 --------------- APPROVALS: ,/ 77/NN•Mrir.+w.++�.... n .., .,..... ............................ N° 4-z G2 NOR7ry O 9 ,sSACHUSf Date.,/.-. /r. r. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform .. 1/f .i�!!.. ��'' `: • : •` ............. • • plumbing in the buildings of ....1: /l'!.'!'r :�'.:.�..<` .. ..Y ... . at .... . .:.............. . North Andover, Mass. Fee..J.... Lic. No .......... ........... �.j. _ :..". ........ PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer r+ Af NO5 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.. . .......... . has permission for gas installation . ......... . < > /a in the buildings of .... . ' ' <,..f i :......................... . �. - ,, at ......... % .. .................. . North Andover, Mass. Fee:1?...... Lic. No........... .............. .......... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE PAYMENT VOUCHER PAY T0: Town of North Andover Community Development and Services 146 Main Street No. Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December January to March FOR Repairs and Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00/per. 4 iTOTAL PAYMENT: $1,500.00 Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: DISTRIBUTION 2 DATE: 7 -Jan -00 Amount $ ------1,500.00 ----------------------- ----------------------------- ----------------------------- No �! Date...l..1../...� NORTIr °et"`° '•�"° TOWN OF NORTH ANDOVER l ' PERMIT FOR WIRING This certifies that......VY)R ' 4 . r'. 0 .1..F ..�% �- ...................................... ..................... ............... has permission to perform ........ �An.!,nJ,..(A.......... e�.0?. u1(.. r ............. "wiring in the building of ...... . a..wl..�...................................................... I'(at ... �..5�.........� 4 �. Lyr f../.!.�....... ' �_.....North Andover Mass. Fee...%.�......... Lic. No. . ELECTRICAL INSPECTOR O/12/99 12:12 79.00 PAID WHITE: Applicant CA ARY: Budding Dept. PINK: Treasurer f MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 22 -Sep -99 PAY T0: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 1 CHECK STUB Quarterlly Permits 1 INF�-�-� is October to December FOR Repair and Maintenance Permaits WHAT: Plumbing, Electrical and GasElectrical and Gas $250.00 each. TOTAL PAYMENT: $750.00 Account No. 04-6010-39 APPROVALS: DISTRIBUTION Amount -------$750_00--------------- ----------------------------- ----------------------------- ----------------------------- 00, p`PIN BATCH INVOICE NO, INVOICE DATE TP GROSS DISCOUNT NET 9''701. 30--1,31-R--99 )0003 INV3643 000,220 22 -•SE. .-9 7:5 t) 1)0 0400 750 * 00 CL) TOTAL 750,.00 01.00 7150 6 00 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 N2 2 J /�. Date .. ...........?...: TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. . '-` .................................. � has permission to perform ..........?.'....1............................................... wiringin the building of ......... ....`....:............................................................. at .......... �. .................................................. . North Andover, Mass. Fee. ................ Lic. No .............. ............................... <...... ELECTRICAL INSPECTOR Check # Ll WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N2 1779 Date..? P.4*) ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... . ..... . ...................... has permission to perform ..... ............................................... wiring in the building of ...... oo!k. A. A. 4. � ....... & .. at ......2..1.. .................................. . North Andover, Mass. Lic. No...:77777= ............ k ...... /EdcrRiCAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Date .. 2.:... t ` .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......,�.. ...1r t!%' `.. ....`....................... '41011` has permission to perform .......................................................... wiring in the building of ,�`�..!..: � ....................................................................... A at ...... ................................ North Andover Mass. Fee;?..1,'.4:..1....... Lic. No....::-- .: ..........................:..........:...........:...... EL$CfRICAL IxsPECCOR 07/22/99 13:23 250.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BATCH INVOICE NO. INVOICE DATE TF GROSS DISCOUNT NET 1 92701. 01.•-,1tIL -99 2000d1. lNV01.1. 111641 11•,x). t)0 t) a ()c 750 * 00 ^ I� TOTAL 750 t. 00 0.00 750 a OO MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 f a J/ MERRIMACK COLLEGE PAYMENT VOUCHER PAY T0: Town of North Andover Community Development and Servics 146 Main Street North Andover, MA 01845 CHECKSTUB Quarterly Permits INFORMATION: July to September DATE: 28 -Jun -99 L' M FOR Repair and, Maintenance Permits WHAT: Plumbing, Electrical and Gas $250.00 each M� TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- N° r :7 I Date ..... —171../ ... TOWN OF NORTH ANDOVER • °c p PERMIT FOR WIRING certifies that M C �� +. ` r1h C. c 1. This �, ((E c Q .....................................................1.................... has permission to perform .......Q.f , l ��', r P.� k.+ � A.& ........................ ........ wiring in the building of ... . �Ck.'m.-.............................................................. at .... 3.1..i.......1.�..?.:!..P? :E.... ST.....................r... , North Andover, Mass. 'Fee... ��:. ...l1J Lic. No..�?!` ;It .....��,ZZ./t .� �.................. 07(044qjk / ELECTRICAL INSPECTOR lEf4� i9 7� 50. oo PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BATCH r INVOICE NO. INVOICE DATE TP GROSS DISCOUNT NET 92701 1,5._.,.I11►_ --- 99 2000011NV1 ?0 • 11182i 07•-•,JUL-9 750 * 00 0'.00 750 o OO TOTAL 750.00 01100 750400 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 MERRIMACK COLLEGE PAYMENT VOUCHER PAY T0: Town of North Andover Community Development and Services 146 'Main Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: April to June FOR Repair and Maintenance Permits . WHAT: Plumbing, Electrical and Gas $250.00 each -r TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ -----------------------------* DATE: 7 -Jul -99 Amount $750.00 ----------------------------- ----------------------------- ----------------------------- ----------------------------- N° ; a l J Date ....... !.../�.....!..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING I' I b + C, a s -T-,t This certifies that '� �` �� (Ot( �L iY, P R 2 has permission to perform ... tICL.0.. �: f...�.........iI`.'..t..1, 0,11 !.. t.S................. wiring in the building of ............................................................. at ... ....1J .............. �1 , r� <.... ..................... ..>North Andover Mass ` .v....`.v?...1 ..........'1 /ELECTRICAL INSPECTOR 03/16/9'3 �2; i��rr ='RID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BATCH INVOICE NO. INVOICE DATE TP GROSS DISCOUNT NET '► 92701 2 5...F e1)-...99 1991?08TNV163 1.1)903 1.6 -Feb -99 750.00 0110c 750,00 TOTAL 750.00 0.00 750.00 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 19 a9s�,G 3R0201. MERRIMACK COLLEGE 1-�t''"`� �"-� � CA7 PAYMENT VOUCHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December DATE: 14 -Sep -98 FOR Repair and Maintenance Permits WHAT: Plumbing, Electrical and Gas - $250.00/each r TOTAL PAYMENT: $750.00 ,r 10 5 8 2 DISTRIBUTION Account No. _04_6010_39___________________ ------------------------------ ------------------------------ ------------------------------ APPROVALS: If Amount ------- $750.00-------------- ------------------------------ ------------------------------ ------------------------------ BATCH INVOICE NO. INVOICE DATE TP GROSS DISCOUNT NET 92701 17 SeF--98 1P903 U-10.804 1.0`-, 37` 1.4---Seta-•9 7...7t)a00 0000 750.00 TOTAL 750(00 0000 750<OO MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 11 Date ..... ��..... . 3822 HORTM 3?�.,��•°;.�o0L TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING 'SS�CMUS�� This certifies that-. !' - -•r-� .......... ...... has permission to perform . ..... . .... 4i�w plumbing in the buildings of ......................... .... at... - ...?j .. , North Andover, Mass. Fe r 1.. Lic. No.. `........ ......... I .................. . PLUMBING INSPECTOR 49/22/98 25:09 2N.0 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer rj0MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ype or print) 2 t P - NORTH ANDOVER, MASSACHUSEJ`TS Date Building Locations ¢ d4l R r K ! G (C-5ag Permit 7v, -k y l f L �i Amount ,7,—p_ / Owner's Name New Renovation Replacement Plans Submitted ri FIXTURES (Print or type) Check one: Certificate Installing Company Name Corp. Address Partner. f Business Telephone Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: 11Liability insurance policy Other type of indemnity Bond 11 , Insurance Waiver: I, the undersigned, have been made aware tlfat the licensee of this application does not have any one of the above three insurance Signature Owner Cl Agent 13 best of my hawk* and that all phmmcing WO& and MSMb8& as pa'armcd oda PCM& lid br tfms zpf6clfim W& 70-- in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By:ign re ot Licenseaum er Type of Plumbing license Title City/Town License Nmer Master Journeyman APPROVED (OFFICE USE ONLY C-4- - J00, MERRIMACKCOLLEGE �9 AUK—Eff VOUCHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: October to December FOR Repair and Maintenance Permits WHAT: -Plumbing, Electrical and Gas - $250 00/each TOTAL PAYMENT: $750.00 1 058- 72 DISTRIBUTION Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: DATE: 14 -Sep -98 Amount ------- $750.00---------------- ------------------------------ ------------------------------ ------------------------------ J 4". C 9- .0� Date ............... !;;2 ..... No � ... ... 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING .1i This certifies that..,.,. ......... . .........:r+ ................ f—� .............. . . .... . .... .. ....... has permission to perform ...... ... .... wiring in the building of..'. .............. .................. ...... at .................... ..... North Andover, Mass. -j- FeeC� ................. Lic. No ............................................................................. ELECTRICAL INSPECTOR 00 WHITE: Applicant CANARY: Building Dept' ' PRK�lTreasurer N - 'oma i 3 V Date ... ZAA,7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that (t t� 4t...`............5:.. f .1 .......................... .......................... / has permission to perform........... �� wiring in the building ofS R In -Q ............................................................................... ............................. . North Andover, Mass. at ................................ ........... Fee ....75 : w. Lic. No.U`' —(2.e. ................................................................ ELECCItiCAL INSPECTOR col 0 S^ y () r? 3 ted Q.T' 9�,' 07/10/98 08:54 750.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Bi ;CH INVOICE NO. INVOICE DATE I TP GROSS DISCOUNT NET 92701. 02-Jul-98 199901 T. NVO 10 1()464 ;s��.... hlf-1_.91 750,00 0400 750 d OO TOTAL 750,.00 0.00 750.00 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North ANdover, MA 01845 CHECK STUB Quarterly Permits INFORMATION: July to September FOR Repair and Maintenance Permits: WHAT: Plumbing, Electrical and Gas - $250.00 each.. TOTAL PAYMENT: $750.00 104641 Account No. 04-6010-39 ------------------------------ ------------------------------ ------------------------------ APPROVALS: DISTRIBUTION DATE: 26 -Jun -98 Amount ------- $750.00---------------- ---------------------------- ----------------------------- f NP/ Date .. . ....... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING -'0 This certifies that .... Nle.a.!.Mci C if Co I If' ........................ ...... 0 ( 4 has permission to perform ...�it/rii,)' wiring in the building of .......... C Q ... M ............................................................. at ......... ............... . North Andover, Mass. co 0 Fee ... 7�.� .!.q ... Lic. .......................................................... ELECTRICAL INSPECTOR C 03 5W1 J aa V WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BATCH INVOICE NO. INVOICE DATE TP GROSS DISCOUNT NET .a 92701 08---(% r--98 199131.01MV031 I 1.031.3' 31-Mar-911 15(1.:00 0 * 01 750.00 TOTAL 750.00 0.00 750 00 MERRIMACK COLLEGE NORTH ANDOVER, MA 01845 MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 31 -Mar -98 PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 K STUB Quarterly Permits ATION:_April to June FOR Repair and Maintenance Permits: V AT: Plumbing, Electrical and Gas $250.00 each. MENT: $750.00 I DISTRIBUTION No. Amount 39-------------------- ------- $750.00--------------- .PPROVALS: `rho 'i—j u Date.......5Ar NOR71y °et •�"° TOWN OF NORTH ANDOVER lip PERMIT FOR WIRING This certifies that ......;11 E: �c i1 .11 u.C..��........�.. :. �. I. �..................... has permission to perform .... 1�. .... , ..t . �..... � . f ��. �.4 ...... wiring in the building of ....... :. d....... ............................. at ............. !4 � L)..( ..................... . North Andover, Mass. Fee..4A:�. Lic. Noq! .C:`. (�..................... .............. ........................... ELECTRICAL INSPECTOR /S5T O �, k'4798 10:49 250.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE PAYMENT VOUCHER DATE: 5 -Jan -98 PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, Ma 01845 CHECK STUB Quarterly. Permits INFORMATION: January to March FOR Repair and Maintenance Permits: WHAT: Plumbing, Electrical and Gas $250.00/each TOTAL PAYMENT: $750.00 101509 DISTRIBUTION Account No. Amount 04-6010-39 $750.00 ------------------------------------- -------------------- -- Dat ............. • a` 31 0 3 TOWN OF NORTH ANDOVER g �? 0 ' PERMIT FOR PLUMBING g �, '°•,.�° q''`ty SA HUS This certifies that .f4./�` l has permission to perform .... g plumbing in the buildings of .................................. at ...................................... North Andover, Mass. g Fee). Lic. No .......... .... ... ............... . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1 � �) J i Date ..................... i, NORT11 TOWN OF NORTH ANDOVER py 4•�ao ,e 1,t,OL A tic PERMIT FOR GAS INSTALLATION This certifies that V r.. •�G • r t �• has permission for gas installation ..,. p•' .�' • • • • • • • g in the buildings of ...�',�j". h ..-.................. • ...... at..................................No`rtthh Andover, MSss. Fee.'. S .v,.:. Lic. No........... ... ...... . AS INSPECT R WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE P,q_ VO CHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover MA 01845 CHECK STUB Quaterly Permits INFORMATION: Jul to Se tember FOR Repair and maintenance permits: WHAT: Plumbing, Electrical and Gas $250.00/each TOTAL PAYMENT: $750.00 DISTRIBUTION 102913 Account No. 04-6010-39 -------------------- ------------------------------ ---------------------- ------------------------------ APPROVALS: y DATE: 8 -Jul -97 Amount ------- $750.00--------------------------------------------- ------------------------------ ------------------------------ - 1 5 1997 MERRIMACK COLLEGE PAYMENT VOUCHER PAY TO: Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 CHECK STUB Quaterly Permits INFORMATION: October to December �--/4011 Repair and Maintenance permits: WHAT: Plumbing, electrical and gas $250.00/each TOTAL PAYMENT: $750.00 DISTRIBUTION Account No. 04-6010-39 ----------------------------------------------------------- - l DATE: 29 -Sep -97 Amount $750.00 ------------------------------ ------------------------------- ------------------------------ ------------------------------ Date 3 3 -12 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that -,- ......... has permission to perform ... ................ plumbing in the buildings of ...A.< <......................... at A. -.r , r-, ......... , North Andover, Mass. Fee r? !? ' .. Lic. No .......... ............................. . PLUMBING INSPECTOR 04/29/97 15:22 250.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer T2 314 0 rw SA U Date ........... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... .".C-kx .......... Ca... C has permission to perform ....... mx!?: t ..... ?r?l wiring in the building of ....... ..................................................... at ....... 2.LJ�7 ..... TtA.iu,-vAT ....... ............ . North Andover, Mass. ............................. Fee ... Lic. No . .... ............. ELECTRICAL INSPECTOR ................. --;� ,- 07/ C �1) -'066 11.3 54 s 2W. 00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TO Date.... 1208 HORTM :°1" -TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING " S U This certifies that ....ISI` e-An.I.M.0o;A ........ Co. E..q..v ........................ has permission to perform ....M-tAl'..� ......... 9 R.IMST .................. wiring in the building of ...........�Ck.t&C C. ................................................... T�A North Andover, Mass. at .... Fee'IX,04Lie. No. 9".. i!'6 d ........................................................ ELECTRICAL INSPECTOR C It 70/1 M. 00 PAID waxquo-.43 WHITE: Applicant CANARY: g Dept. PINK: Treasurer i - Date.................................. 'a 1058 NORTH °�< ;•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACNUS� This certifies that .....`.��t.�..��..'.0................................................ has permission to perform ...........11?. .... ......................................... wiring in the building of ..... at...........................................................................�, North Andover, Mass. '. Fee ..d .?..0 ...:.... Lic. No .............. .............'............ .... .. :`1:........ L/ ELECTRICAL INSPECTOR f� r d WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MERRIMACK COLLEGE 1947-1997 Town of North Andover Community Development and Services 146 Main Street North Andover, MA 01845 April 17, 1997 Enclosed please find a check for $750 to cover plumbing, electrical and gas permits. This should cover the second quarter, April to June. Please send permits to the address listed below. Mr. Robert Coppola, Director Physical Plant Department Merrimack College 315 Turnpike Street North Andover, MA 01845 Thank you, Ursula Maggio, Secretary - /m (Ck. #043787- $750) APR 2 3 1997 315 TURNPIKE STREET NORTH ANDOVER, MA 01845 508-837-5000 O N(IH 111 '1,Y . t ,11STAC MUSf� 5 o a�` Date ...........7 ... /U.(.. . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... Y.r..i..c,(C.k.v(n.C.A.\ has permission !o perform ....... wiring in the building of ........�...�.�..t Y:�..': e ......... at ....... ;,..,..>.............4c.,..r!..`'........a.1................ , North Andover, Mass. I 1 Fee... 0:3. No.....(�r.;.�'`�.1�............................................................ ELFCTRICAL INSPECTOR 071101% -11:34 250.00 PAID WHITF: Applicant CANARY. Building Dept. PINK: Treasurer L«s-t c�'� ��q ` pec sv F;- so VA QT- tV97 7 2050 Date .... / - .. .. o, ............. pORTIy TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION; This certifies that has permission for gas installation 1A, ing *n the buildings -of . �it� �l�rtll ('�4 • .._._sem ;at North Andover, Mass. Fee 450. Lic. No.. /(). cl . .......................... GAS INSPECTOR WHITE Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) k6,�tT rwt 1C� NORTH ANDOVER ,Mass. Date kuild"Ing Location 3 I5 (� S i Permit 0�0�'77 SIM* A'UV-60FW tg* a/ F" f f Owners Name M 8eS_-rrt /.i. ,Ir cOL(,AS�g 6 New '7 Renovation T] Replacement p Plans Submitted Y?A- TA41KIFE J - FIXTURES (Print or Type) Installing Company Name Address Check one: Certificate [-j Corp. Partner. Firm/Co. Business Telephone: Sbe- 8�37_,S`1l d'' Name of Licensed Plumber or Gas Fitter 1214N0y >e�D�i`7 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F� Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent I hereby certify that ad of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing worst and installations pafonned under' Permit itwed for this application will -be in compliance with all pezfineot provisions of the Massachusetts State Gas Code and Chapter 14: of the General Laws. , By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman f 0j 19 - APPROVED (OFFICE USE ONLY) --- License Number Y : Y Y • MEN No N� E ENEEMEMEM soamossommmmsii sesmiai■ .. »»■ RARE MEMEMSEMSEMES 0 monsoon (Print or Type) Installing Company Name Address Check one: Certificate [-j Corp. Partner. Firm/Co. Business Telephone: Sbe- 8�37_,S`1l d'' Name of Licensed Plumber or Gas Fitter 1214N0y >e�D�i`7 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F� Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent I hereby certify that ad of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing worst and installations pafonned under' Permit itwed for this application will -be in compliance with all pezfineot provisions of the Massachusetts State Gas Code and Chapter 14: of the General Laws. , By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman f 0j 19 - APPROVED (OFFICE USE ONLY) --- License Number if Date. .. as ... ......... . NORTH TOWN OF NORTH ANDOVER pF .ao ,a1ti0 � p� PERMIT FOR GAS INSTALLATION s n y +.eo•.4y IJ This certifies that .......................... .. . tas permission for gas installation f':'.X, r• iq the buildings of `.`.......: � • �_ ?' • • • • • • v �u at North Andover, Mass. °� Lic. No.. GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATOR FOR PERMIT TO DO GAS FITTING or print) ivvn I H ANDOVER, MASSACHUSETTS Date �� L 19 S 1— Building Locations ,Ll A,WAr h? i!! -v Gly C= Permit # Ij Amount $ ^p Owner's Name New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name 1 ❑ Corp. Address ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter ot JSURANCE COVERAGE Check one: Ijave a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the tvpe coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: 7,Ve City/Town PROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ® Gas Fitter License Number er ❑ Master ❑ Journeyman m .L 5 w .ri z z C m a N z •.raj W W z w rw ti N W N W 'r U Z W w L .� L- �, C C W bIcl : C w z 't C -r � C C w P SUB-BASEM ENT BASEM ENT IST.. FLOOR 2N D. F L 0 0 R 3RD. FLOOR 4T11. FLOG R 5TH. FLOOR 6T 11. FLOOR 7'r 11. FLOOR 8TH. F1,00 R (Print or type) Check one: Certificate Installing Company Name 1 ❑ Corp. Address ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter ot JSURANCE COVERAGE Check one: Ijave a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indicate the tvpe coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: 7,Ve City/Town PROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber ® Gas Fitter License Number er ❑ Master ❑ Journeyman