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Miscellaneous - 350 WILLOW STREET 4/30/2018 (2)
0 r- Date. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ......... .., �:.. . has permission for gas installation ...1.. C......... ... ........ . in the buildings of . . /./'! !.`..' ..................... at ...3 >. r :. � % . � . (!.:- :.............. . North -Andover, Mass. Feet! '�` .. Lic. No..G/f. GAS INSPECTOR r Check # ///I L X362 MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FrrrI iG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations 3 W /�G w -5� Permit #. Y) C L Amount .$ i )= Owner's Name Z� NewEf Renovation ❑ Replacement ❑ Plans Submitted 0 (Print or type) NT--- "Fie C Cil gene: Certificate Installin Company j ,i' Corp, ao 7 ❑1 Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter A, -t e 1 � Ga d INSURANCE COVERAGE • t-necx on I have a current liability Insurance policy or it's substantial equivalent. Yes No [3 If you have checked yes, please i tate the type coverage by checking the appropriate box. ❑ Liability insurance policy Other type of indemnity 1:1 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 I hereby certify that all of the details and information t have sunmtttea kor enterea) in aoove appucaaon are true anu accurate to me 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. VED (OFFICE USE ONLY) ,Xignature of Licensed Plumber Or Gas Fitter 1/1 Plumber Gas Fitter License Number ��� f Master Journeyman t, FLOOR ,IST. pjym (Print or type) NT--- "Fie C Cil gene: Certificate Installin Company j ,i' Corp, ao 7 ❑1 Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter A, -t e 1 � Ga d INSURANCE COVERAGE • t-necx on I have a current liability Insurance policy or it's substantial equivalent. Yes No [3 If you have checked yes, please i tate the type coverage by checking the appropriate box. ❑ Liability insurance policy Other type of indemnity 1:1 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 I hereby certify that all of the details and information t have sunmtttea kor enterea) in aoove appucaaon are true anu accurate to me 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. VED (OFFICE USE ONLY) ,Xignature of Licensed Plumber Or Gas Fitter 1/1 Plumber Gas Fitter License Number ��� f Master Journeyman Location',�O'"''� C No. &6 -3 Date °f ti TOWN OF NORTH ANDOVER ,. 3?- . ••°� Certificate Occupancy $ of �'s'•••° • t<�' s�GNUs Building/Frame Per Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTALI-�-a� 441� $ Check 18936 `"Building In p ctor Korn s CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 363 (11110/20051 Date: January 1$ 2006 THIS CERTIFIES THAT THE BUILDING LOCATED ON 350 Willow Street MAY BE OCCUPIED AS Tennant Fit Out Commercial IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH, OTHER REGULATIONS AS MAY APPLY. Certificate Issued to; &Whi &qft Trust ASO Willow Street North &toovSr MA.0 1845 i dm pector ft i k i J 9-1 a 2 O W O CD L O ZCL co O H 0 � c c CO) 0 �E m Cc co 04) CL � � L !O O a a. o, a HCc C cl y Z V V co C C C C. CO) cm LLI W OAC lz W U) O p C r.+ �V V nc ea � �o U b` MM W o U0 4 J 9-1 a 2 O W O CD L O ZCL co O H 0 � c c CO) 0 �E m Cc co 04) CL � � L !O O a a. o, a HCc C cl y Z V V co C C C C. CO) cm LLI W OAC lz W U) O p C r.+ �V V nc ea � �o J 9-1 a 2 O W O CD L O ZCL co O H 0 � c c CO) 0 �E m Cc co 04) CL � � L !O O a a. o, a HCc C cl y Z V V co C C C C. CO) cm LLI W OAC lz W U) loo u o • -H o u o o �o a Ln ii Ln N o O II o o Q 0) u rn ®\ In M o p iN N O 41 O II O o II O N �A O o II o U 41 O U N (0 10 U) ICI Q r H U Q) Q 0 O II o O o II o .11`1 II Y O iI O rl m N N P-41 m �I N O II O O U O II o �4 RS Ln II Ln Arlo u O rn u rn i 1, O II o C O II O �F II Ln II Ln N O II O U Ol II Ol ,K O M-1 rl O Ln H -rl cr .I.-1 �4 00 (d rl rl O rl LU' �;. O U .� i 4 N Q a rx � N OH O M J-1 z v �, -H o O PU U 41 N -E a 0 4 o 30�4 �> �4 O • O N Haz Ha Gerald A. Brown Inspector of Buildings TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-9545 Fax (978)688-9542 AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2, the total estimated cost of the construction including all related construction costs* of the building located at 350 Willow Street South, North Andover. MA amounts to It 210.000. the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work done with or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating, electrical, air conditioning, painting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment are not part of the total construction costs. Signature of Owner COMMONWEALTH OF MASSACHUSETTS Essex S.S.January 10 20 06 Then personally appeared the able named _,�[ L3{�YGT �)� and Made an oath that the above statement is true. Before,, Me , Jane i. Armstrong �� ! NOTARY PUBLIC My commission expires Oct. Notary OFFICIAL USE: Final Cost: Original Estimate cost of general work: Cost Difference: Additional Fee Required: TO AMEND FEE UNDER PERMIT NO.: Inspectional services Department 2005 C, F:\finalcostaflidavitform Strict code enforcement makes the town safer Before buying, renting, leasing check zoning 04 "° 9T "qti TOWN OF NORTH ANDOVER OFFICE OF s f BUILDING DEPARTMENT 400 Osgood Street ��S�nfHU��K�9 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 CONTROL CONSTRUCTION —SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BUILDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER, MA 01845 I, Ronald H. Albert, AIA HEREBY CERTIFY THAT THE ARCHITECTURAL PORTION OF THE WORK RECENTLY COMPLETED AT 350 Willow Street, North Andover. MA UNDER PERMIT # 363 , DATED November 10, 2005 DOES CONFORM TO THE MASSACHUSETTS STATE BUILDING CODE. AUTHORIZED SIGNATURE: DATE: A lam REGISTRATION: _0 j o No.4627 a ' HAVERHILL, OZ MA acv q,TH OF MP 62u7 ir Date�.::. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...................................:................................. has permission to perform • .J.... ................................ wiring in the building of .... ... at7-45-0 /1, .f-*�-�<!! �.. ............ . North Andover, Mass. ...................... Fee,7)............. Lic. No//C?/?1 .... ...... : .......�iwsip�Elc��ro ............. ELECTRI// Check #� �- V rN Commonwealth of Massachusetts otUse Only Official Department of Fire Services Permit No.snow � 0 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked , [Rev. 11/99] leave blank M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11/11/05 City or Town of. No. Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 350 Willow Street Owner or Tenant. Eastprint, Inc. Telephone No. 978-975-5225 Owner's Address Same Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Manufacturing Utility Authorization No. Existing Service 2000 Amps 120/208 Volts Overhead ❑ Undgrd ® No. of Meters 1 New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity (1) 800 -amp 120/208 Location and Nature of Proposed Electrical Work: Provide equipment power and lighting to new manufacturing area Completion ofthe follnwinu tahle may ho waivod by the Incncrtnr nfWirnc No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Transformers 2 KVA 262.5 No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 22 Swimming Pool rnd. ove n- rnd. ❑o. o Emergency Lighting 3 Battery Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches 2 No. of Gas Burners 2 No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. 1 Total 10 Tons No. of Alerting Devices I g No. of Waste Disposers Heat Pum Totals Number Tons KW ........... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances 4 KW 115.2ecuritySystems: No. of Devices or Equivalent No. of Water Heaters KW o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors 8 Total HP 54 Telecommunications Wiring: No. of Devices or Equivalent OTHER: (11) pieces of manufacturing equipment Attach addition[ detail f -desired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete- FIRM ompleteFIRM NAME: Hammond Electric, Inc. LIC. NO.: 11011A Licensee: Paul J. Hammond Signatu a LIC. NO.: 25730E (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.- 978-373-9979 Address: 60 Railroad Street Haverhill, MA 01835 Alt. Tel. No.: 978-210-1900 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $172.50 10 11 Location'?S-0 No. � Date10 �� S HQRTiy TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ o� •• a Building/Frame Permit Fee $ /7z �CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #40747- 18766 4 Pt, - << Building Inspector' a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING This Section for Official Use Ojilvlll 9=1 x -32'a BUILDING PERMIT NUMBER: DATE ISSUED: 119 SIGNATURE:2,-2,,---���, Building Commissioner/1 or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number 14A2. 4 "M 2--!9 - Number Parcel Number —4464Map 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDistrict ProfoiedUse 1A Frontage Area (sf)- 1.6 WELDING SETBACKS (ft) et cd. `'- -T-W e -,Q t3) Front Yard Side Yard Rear Yard Required Provide Required Provided —Required Provided 1.7 WaterS G.L.C.40. St 54) PP"PzrMft ; 1.5. Flood Zone hdormation: Zone Outside Flood Zone P--- 1.9 Sewerage Disposal System: on Site Disposal System 0 Public D NO MISS, 2.1 er of Record U) Name (Pn* Address for Service : AX -/A) 9SONJ 9-717- P�,A Signature Telephone 2.2 Autho Agent 402 J4 Name t dress for rvice: Signa Telephone 371 Licen nstruction Supervisor Not Applicable 0 - k3dress License Number .0 on' "u vsor' Licensed CTons Expiration 'In " e 00 X77 Si Telephone li bl, er. Not Applicable L Improvement Not Applicable 0 3,2 Registered onte Improvement Cntrrat., Registered Company Name,. Registration Number Address Expiration Date Signature Telephone -0 M 1 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea ....... No ....... ❑ SECTION 5 PR©F#©il)i�N3r k it3'1Ci w$3'FiS C4N�';Hi�3CTION Ct��bL �R�'TE'1t ��1t �+�►� ���i�b !G'�:�?$tSI�D �i'�i 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility . Name: _ Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Name Area of Responsibility Address Registration Number Expiration Date Signature Telephone ' c - Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date v a� e Compan ) C— Not Applicable ❑ Responsible in Charge of Construction New Construction ❑ Existing Building ❑ Repair(s)❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify _ Brief Description of Proposed Work: n Alterations(s) Addition ❑ A Assembly ❑ A-] ❑ USE GROUP Check as applicable) CONSTRUCTION TYPE A4 ❑ A-2 ❑ A-3 A-5 ❑ ❑ IA ❑ B Business ❑ I B ❑ C Educational ❑ 2A ❑ F Factory H High Hazard ❑ F -I ❑ F-2 ❑ 213 2C ❑ 4 IInstitutional ❑ I-] ❑1-2 ❑ 1-3 3A ❑ 0 M Mercantile ❑ 3B ❑ R residential ❑ R-1 ❑ R-2 ❑ R_3 4 ❑ ❑ SA S Storage ❑ S-1 ❑ S-2 ❑ ❑ U Utilityp Specify. t 5B ❑ M Mixed Use ❑ Specify S Special Use ❑ Specify: P r, COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, AD------------- DITIONS AND OR CHANGE IN USE Existing Use Group:_ Proposed Use Group:_ Existing Hazard Index 780 CMR 34:_ Proposed Hazard Index 780 CMR 34: 3 BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Areas Total Height (ft) Independent Structural Engineering Structural Peer Review Required Yes ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT No -8-- Owner of the subject property Hereby authorize9?,ahe--,i 4Z�-- My behalf, in all matters rMativE two work authorized by this building permit application Signature o r Date to act on 1! 1, `J Q ✓! as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name 6 Signature of r/ ent Date Item Estimated Cost (Dollars) to be $3�1� Completed by permit applicant 1. Building 25'Lo0 (a) Building Permit Fee o Multiplier 2 Electrical Ste, o (b) Estimated Total Cost of Construction from (6) 3 Plumbing O V 0 v Building Permit fee (a) X (b) 4 Mechanical (HVAC) �• 2s� o 5 Fire Protection � Wv 6 Total (1+2+3+4+5) f s Check Number .•'�.'d'�;igi ,,.� �4k '�),. "' � z : 3 s" � - , Z'"'I q�k t�,-;,.a -��,"�£�f�fi�'sP �7.-y{Y $��,...: ��u;r,'r} r"a;,;lt, ��4���r� .._ �".<. +�g ,.. .d' }�.:���y. .,.ti;, �:��P: +.z�� �.a cy....�-.. NO. OF STORIES SIZE 3 Ga oc o BASEMENT Orl SIZE OF FLOOR TIMBERS tv, /4 1 sr 2 No 3 RD SPAN /V/ j I DEMENSIONS OF SILLS N DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION N /4 THICKNESS /A SIZE OF FOOTING N X MATERIAL OF CHIMNEY IS BUILDING ON OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �`h�',� ��',,+ �....�-tiL`et'•.. •d�•�va ...... 1% s. .r�,r: �.. 4E�'$Y' a...'S•�u c.....:.�%'��.,.srt-i''�,��"5+'Yae'.E++��`'s�4y`S^' .i���,..cM>{$.'�a'fJ.�y. i•"�'C� F a�'��. <i O z W W V.; ca a° a Ccda w° 1:4 U r.ch x a a ; o°G w a w w a�' � w a WU C2 w rA z cn W �o m C • C O 7 imo y c 0 0 t.3 'y`av d C A A O O "Ea m c r 0:C d N OCxL o mcm C W d .mm O ev a N O tg JC C L _ �o c= v y Z O O.� O N C a m �ms3 F�— $ N m $ H W C O+L•�Z WfA � o m•ted= C O 'E E.� o co QCD OF - a •:9 � O Z as L o.4�CID N 45 N O N C � w CD Of c CC 16. m a O cm C I•.0 IMM s 0/ f c m O C • L .�+ O O v Z m CL O y o c O cm co) O GD.� H O O 'E m m CD C3 0 CL — co Lft CD 3.0 CD L o CL C Q o •� env C.3 .5v C G3 0 CL V CO) � C C� CO) 0 LLI 0 y uj Y/ W W 19 W CA BOARD QF BUILDJNG REGULATION$ icense-CQNSTRUC710N SUPERVISOR N 029376 Birthilat� 021281153 Tr. no: 16406 Epi�es 0212?;/?Q06 Restricted 40 ' STEPHEN E FOSTE.Rl. 46 MEADOW LN - N ANDOVER, MA01846 Acting c Ms, over f rUKM U - LU 1 KCLCAQC r%imm INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT D v a►� ��J - �-� PHONE C� 0 3 329 ; ava LOCATION: Assessors Map Number_, �_ PARCEL SUBDMSION LOT (S) STREET S ``�L✓y yy ST. NUMBER 3,$�'d (— OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS FIRE DEPARTMEN 'ECEIVED BY BUII ROVISW 9197 JM OFFICE OF BUILDING INSPECTOR � TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: Eastprint Interior Modifications PROJECT LOCATION: 350 Willow Street NAME OF BUILDING: Eastprint, Inc. NATURE OF PROJECT: Interior renovations IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Ronald H. Albert REGISTRATION NO. 4627 BEING A REGISTERED PROFESSIONAL EN86MITMARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT • ARCHITECTURAL • STRUCTURAL • MECHANICAL • FIRE PROTECTION • ELECTRICAL • OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. 2 /�" SIGNATURE SUBSCRIBED AND SWORM TO BEFORE ME THIS >ts, DAY OF November 2005 aj_n _ Nn, ARY PI IRI Ir MY rOMMISSION FXPIRFS jW VhA Property Owner Name: Job Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 Workers' Compensation Insurance Affidavit City: Phone # ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in anv capacity. M I am an employer providing workers' compensation for my employees working on this job. Company Name: Dutton & Garfield. Inc. Address: 43 Gigante Drive City: Hampstead, NH 03841 Insurance Co. Infantine Insurance Company Phone # 603-329-5300 Policy # WCA005753215 ❑ I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: Company Name: Address: City: Phone # Insurance Co. Policy # Company Name: Address: City: Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and or one years' imprisonment as well as civil penal 'es in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded toOffice of Investigations of the DIA for coverage verification. I do hereby certify under the pains and Print Name Ste' ./Foster provided above is true and correct. Date 11 Phone # 603-329-5300 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/license # ❑ Building Department ❑ Licensing Board ❑ Check if immediate response is required ❑ Selectmen's Office ❑ Health Department Contact person: Phone #: ❑Other 4 Z�`vl 17" IL Te LOT (p 4 10 0— U fp—AA-f'1- INV, I. INV. I't I, \ HYDRANT IN WON 9b 01 # 0), 101 No 270"3 Date./..... Z� .Zf? TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ r ............:....:.:"..;.....:......:......... fir................. has permission to perform. p..: �- ................................................................... wiring in the building of ...:..... �..A .: fir+ :. ............................................. � at:.............................................-'.:......................... . North Andover, Mass. Fee.!...? ............. Lic. No.............. ............................................................... / ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Location 1,330 �O./ S No. L' Date Np"T" TOWN OF NORTH ANDOVER .6 OL Certificate of Occupancy $ -_ MUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ , TOTAL $ Check # -7 llfj Y Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: JDATEISSUED: C SIGNATURE: v Building Commissioner/Inawor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3 so w Sr. ZS 7 F Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (om � . /S� r&1 ZoningDistrict Proposed � Lot Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided V �(j' j Irl). -o ' to ' 1.7 Water Supply M.G.L.C.40. § 54) 1.5. Flood Zone brfomration: Zone 1.8 Sewerage Disposal System: Public 9-- Private ❑ Outside Flood Zone -Er' Municipal Q— On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENTS -- 2.1 Owner of Record 3 SJ V-A,:S,,rV 1t C xx —c SN C, lJ . A, U I, Dyc—: Name (Print)Address for Service : -.,X/� Signature Telephone 2.2 Owner of Record: $7/° 1Arr --J;�C, Address for Service: ma���?` - SLSS X/Q3 Si re Telephone S CTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number f�� ¢ �!Ll� Lrt . 4� �., „T1f'K Address Expiration Date Sign re Telephone 3.2 Registered Home Improvement Contractor 11-1/14 Not Applicable °-- Company Name Registration Number Address Expiration Date Signature Telephone MU rn X Z O rn . ( . SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buil ' rmit. Si ned affidavit Attached Yes ...... No ....... ❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 SECTION 6 - RSTTMATRTI C0NSTR1TCTTnN COSTS 1 Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 4 la) oOd (a) Building Permit Fee Multiplier (0, so 2 Electrical dr dad (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) I f 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 a d o Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR 9QNTRACTOR APPLIES FOR BUILDING PERMIT I, (� as Owner/Authorized Agent of subject property reby authorize 1 /4 Ae o, �' 5 � to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWN (E �R/AUTHORIZED AGENT, DECLARATION I, V > � 14c ,q as Owner uorizedAge f subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/ ent Date mg. IMEN MEN NO. OF STORIES SIZE �r BASEMENT OR SLAB SIZE OF FLOOR TI1VIBERS 1ST2 ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Am= 111 111ios 600 Washington Street Boston, iWass. 02111 I.. .. Insurance Afridavit :i�t�i[C�ttt55ntV, teuFt•. n ...-✓-vr..s.:�::.,;.. __ •_.; ;�.�ts�'. -Jt1 - - - name: Dutton & Garfield, Inc. 54 Beechwood Drive .. . .. insurance co aoRcv # c a at ons ee necc= Failure to secure coverage as required under Section 25.E of NIGL 15-1 can lead to the imposition of criminal penalties of a fine up to 51500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties ofpe7juzy drat the inforntarion provided above is true and correct _. r -)A ,Ie ,-,5 /-) November 15, 2000 Print name Jane I. Armstrong Phone4 ( 978) 681-8600 official use only do not write in this area to be completed by city or to- offieisl city or 0 check if immediate response is required permit/License 9 r,Building Department C]Liceasing Board C]Seleetmen's Office C3He2lth Department phos; rtOther FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the alicant and or landowner from comliance with any applicable requirements. to 0 nows W N NowwwwWwwwwong NEWNWON OWN W WE No so mango NoEffinnom-W a 0 DOW 0 so no MENNENNNOW an APPLICANT _Dutton & Garfield, Inc, PHONE ( 978) 681-8600 ASSESSORS MAP NUMBER CQ— LOT NUMBER SUBDIVISION LOT NUMBER STREW Willow Street South STREETNUMBER 350 I mango OFFICIAL USE ONLY RECONWENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATTON ADMINISTRATOR DATE REJECTED CONMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR -'HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONflyIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS COMIv1ENI'S RECEIVED BY BUILDING INSPECTOR DATE Dutton & Garfield, Inc. CONTRACTORS 54 Beechwood Drive • North Andover, MA 01845 Tel.: (978) 681-8600 Fax: (978) 681-7570 DATE: 11/17/00 TO: Town of North Andover 109 Hillside Avenue • Londonderry, NH 03053 Tel.: (603) 425-2600 Fax: (603) 434-9568 LETTER OF TRANSMITTAL Building Department 27 Charles Street North Andover, MA 01845 ATTN: Mike McGuire RE: East Print, 350 Willow Street WE ARE SENDING YOU x Enclosed _ Under separate cover COPIES DATE NO. DESCRIPTION 2 09/29/00 1 of 1 Floor Plan/Permit Drawing 1 11/15/00 Building Permit Application 1 11/15/00 Workers' Comp Insurance Affidavit THESE ARE TRANSIIiIITTED as checked below: x For Review/Approval _ For Your Use _ As Requested _ For Review/Comment _ For Your Information _ For Quote _ For Bids Due _ For Completion For Execution REMARKS: Please contact D&G should you have any concerns/questions. Thank you. SIGNED: Stephen E. Foster surLea BUILDER Cl) m m Cf) 0 m CD o _ CA 'O CD 0 —J CO) _ O _ CO) Cl) C O C CA d CD 0 CD CD a, H co CO) 0 CD 0 C_ 00 ?'fl Ol' =r-� C y 0 Q N = a: c o ,� y 0 M z N m a o �- = ?= CO)� 0, ,.► W 2t d LA. T .. CD �a an d C y N N --1 'O o f m m m a > > N m Q m•O .-► d ii 0 p N- l07 R. Co =r o m N rCL= aCL A m 0 ��: Cn �o m m y : 1� cn m :' cro `• V C d O Is.�.� CD m f"} O Vs N d Q d C a<CD N m e� Z' m � N ` (lj ? N� o A -� � y �, � mm CD OOCD CD Z JC� d l � O mo cn Hm N r+• A� gym: . cn = m � e m � m NZo oCD X m cn O cn o 21 o o Crf g w C�• o 5 b (n a b m M )nq 0 9 0 c 0 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. / Occupancy and Fee Checke42Rtzo—V {Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aoeordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I Z —,_5 —<DC -D City or Town of: j 3 p , A A) D Oy EZ_ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street &Number) e� fs Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building C-0 h, p, J 0. No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the hunector nfWires_ No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures �� Above ❑ In- Swimming Pool rnd. rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE S No. of Zones No. of Switches No. of Gas Burners No. o Det mon and Initiat• Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW o. of elf -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Securityystems: No. of Devices or Equivalent No. of Water I Heaters o. o o. o Si s Ballasts Data Wiring: No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors T P tal HP Te-RcNo. ecatio Wiring: Noo.. oof f Devices or Equivalent OTHER: t Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless ved by the o r, no mut for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that suchcov a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) h (Expiration Date) Estimated Value of Electrical Work V 0 (When required by municipal policy.) Work to Start: t Z — , �j Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the informat'ioon on this application is trd ue ancomplete. FIRM NAME: til? 1 LA-A,� 1 , � I-1 LIC. NO.: Als a g Z Licensee• U) tL-S—L A tc--L S', X-A-YUtt)A ignature 11U LIC. NO.: (if applicable, enter "ex pt" in the license n�uumb,ggr line Bus. Tel. No.* q% � `60 `� 30D Address: I Ci ( 71H-A-yV 1) 1�fi/L Q�D-J4() I Alt. Tel. No .• not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $ OWNER'S INSURANCE WAIVER I am aware that the Licensee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. Date/. r ..� ....�................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................`:'. �... i has permission to perform ..:...... .. .................... ............: wiring in the building of ... ....... '....... ..... at ...:................: ............ , North Andover, Mass. Fee:'...' .............. Lic. No. ............. ........... .................................................... ELECTRICAL INSPECTOR Check # lel,11 7 _ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer commonwealth of Maddachudelli 2eparinwd of7ire Seroic¢d BOARD OF FIRE PREVENTION REGULATIONS Official Use Only . Permit No. 626 �a rY/ Occupancy and Fee Checked l� (Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPL•';IL INF O- R,1L1 ' ON) On(c: City or 'Town of: �q�" To the Inspector of JVires: By this application the undersigned gives notice of his or her intention to perform the Iectrical work described below. Location (Street & Number) (i[Ji��DGl1"%~� Owner or Tenant 11SLG Telephone No. 1'7S,�S,� S'ri' Owner's Address �X)M3f Is this permit in conjunction with a building permit? Yes ❑ No '(Check Appropriate Box) Purpose of Building 1211"11-1r;t — Utility Authorization No. 008/ 6 7 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Anips / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L-0-n� v Cont lesion orthe lolb t ' b! No. of Recessed Fixtures J Lt/7. No. of Ceil: Susp. (Paddle) Fans td r MGY ae n'alvect of the Inspector of IVires. No. of Total Transformers 1hVA No. of Lighting Outlets No. of blot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ ln- ❑ t o. o mergency ig itnig orad. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALAILI•IS No. of Zones No. of Switches No. of Gas Burners No. ol Detection and Initiating Devices No. of Ranges b 'Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Punip lumber _Tons 1C�VNo. - of Sell' -Contained Totals: Detection/Alerting Devices No. of Disliivashers Space/Area Heating KW Local ❑ bltnncipal ❑ Other Connection No. of Dryers Heating Appliances K�V Security Systems: No. of Nater No. of No. of No. of Devices or Equivalent KW K Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total IIP Telecommunications �Virtng: No. of Devices or E uivalent OTHER: - iutacn additional detail y desired, or as required by the Inspector of {Vires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is iii force, and has exhibited proof of same tp th; permit issuing office. CHECK ONE: INSURANCE FV BOND ❑ OTHER ❑ (Specify:) / (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:// 3-00 Inspections to be requested in accordance with MEC R I M-tifj•, «'lifer tl!Kpains antLnenallie4 of peljury, tftat the ittforntation on -Ws apUlicatL F1101 NAAIE:: Ki r_,r -. Licensee: (If applicable en Address:A OWNER'S IN required by law Owner/A ;cnt Signature — Signature to /'exempt'• in the license number line-) /bat. 4 AKVe-?1114 SUR:�rCE WAIVER: I am aware that the Licensee doe. v. By my signature below, I hereby waive this requirement Telephone No. 0, and upon completion. trite and complete. LIC. NO.: /34/y9 LIC. NO. ,gP,1 pS3d Bus. Tel. No.:97f9 -,:973y All. Tel. No.: not have the liability insurance coverage normally I am (lie (check one) ❑ owner ❑ owner's agent. PI'Rt1fIT I'LL: S 014e C1ommonwra4 of—massuOuoetto iBepartment of Ilublic 0%afttq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy A Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date S—/ 5' 9>_ (X* or Town of NORTH ANp()_VE To the Inspector of Wires: The udersigned applies for a permit In --form the electrical work described below. Location (Street F Ilum,b(er) -350 461,1l/UGt,— S% Owner or Tenant Owner's Address ��� ) Is this permit in conjunction with a: building perwit: Yr r] No ® (Check Appropriate Box) Purpose of Building 11Y) aAlUFge_11.2 A Iyl Utility Authorization No. Existing ServiceQ-200 Amps 2Q671 Zan Volts Overhead ❑ Undgrnd New Service Amps _/ Volts Overhead ❑ Undgrnd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Meters No. of Meters No. o1 Lighting Outlets 9 9 No. o/ Hot Ibbs Total No. 01 lYanslormers KVA No. of Lighting Fixtures Swimming Pool Above In" gmd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of zones No. of Detection and initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices LocalMunicipal ❑ ❑Other Connection No. of Ranges No. of Air Cond. Total tons No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No. Hydro Massage 1Lbs No. of Motors Total HP OTHER: 00 //W INSURANCE COVERAGE: Pursuant to the requirements of Ma!pachusetts general Laws 1 have a current Liability Insurance Policy including Complejvd Operations Coverage or Its substantial equivalent. YES 1^! NO [ I have submitted valid pr of of Sams to the Office. YES NO C It you have checked YES. please Indicate the type of coverage by checking the approp to box. INSURANCE BOND C OTHER ❑ (Please Specify) Estimated Value of Electri at Work S _ (121xpirstion Date) Work to Start 41-11LI- Signed under the Penalties of perjury: FIRM NAME R i C G _ 13 (t), Inspection Date Requested: A Ucensee - �- --� t "P Signature Roughr.V , I I CPD Final LIC. NO. .LIC. NO. ,. a!c_3 D Address — U " ��� I bo�6 Nf'� c�-P �1, j�} A) k3 I8us. Tel No. All. Zial. No. OWNER'S INSURANCE WAIVER: i am aware Ihat the Licensee does not have the insurance coverage or Its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. PERMIT PEE S X-6565 Date..'s T.) 936 0, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... I ...... .................... has permission to perform ..... ...... K..kkf ... . ................. T wiring in the building of . . .......... `.............. at�.o ... ..... . North Andover, Mass. Fee..Hgn_�V-... Lic.NoJ.��ik.9-.� ........................................................... ELECTRICALN SPEINSPECTOR R 01 197 15:27 Jj& B 00 pAID WHITE: Applicant CANARY: g Dept. PINK: reasurer �J Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. VBOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked�,�' [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 11 / 11 /05 (� � City or Town of. No. Andover To the Inspector �f. k nes.' ---`�T By this application the undersigned gives notice of his or her intention to perform the electrical work described below.' Location (Street & Number) 350 Willow Street Owner or Tenant. Eastprint, Inc. Telephone No. 978-975-5225 Owner's Address Same Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Manufacturing Utility Authorization No. Existing Service 2000 Amps 120/208 Volts Overhead ❑ Undgrd ® No. of Meters 1 New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity (1) 800 -amp 120/208 S&At L'67 469 Location and Nature of Proposed Electrical Work: Provide equipment power and lighting to new manufacturing area C'mmnletinn nfthv fnllnwino tnhlo - Aa ---d A„ th., t., --(' w:,. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans ., ..., — No. of Transformers 2 Total KVA' 262.5 No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 22 Swimming Pool Above ❑ n- ❑ rnd. rnd. o. o mergency Lighting 3 Batte Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 2 No. of Gas Burners 2 No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. I Total 10 No. of Alerting Devices I No. of Waste Disposers Heat Pum Totals Number ...................... Tons ..................... " KW ""'""" ' ..........Detection/Alerting No. of Self -Contained Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances 4 KW 115.2 SecuritySystems: No. of Devices or Equivalent No. o atero. Heaters KW o o. o Signs Ballasts Data Wiring: No, of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors 8 Total HP 54 Telecommunications Wiring: No. of Devices or E uivalent OTHER: (11) pieces of manufacturing equipment littacn aaautonai detau y desired or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Hammond Electric, Inc. LIC. NO.: 11011A Licensee: Paul J. Hammond Signatu a LIC. NO.: 25730E (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-373-9979 Address: 60 Railroad Street Haverhill, MA 01835 Alt. Tel. No.: 978-210-1900 OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $172.50 j a cJ l/ -2 s /�-`Z-z /- (,-06 �d 0 0 0