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Miscellaneous - 350 WINTHROP AVENUE 4/30/2018 (22)
4ZPggOZL-99EELel=qPRIE!3=qOJeas'gPleuop=jeo*�gjd=M8in'g6LeajOlZa£=� PBZ=pn / lew/woo-a16006-pew//:sduq OLZL-5V5-£LV :xeJ Tua5-V u011enaasa-1 ss WfI PIOH eaiis s wogl `Xionouis Juiillf,ue si OJOITI l •sseW fl IQIOH W sn gjIm Diels anoX of p.iemio3 xool am ':e `uoijuAiosaa inoX qj!m pa:niuigns uaag omq somonjoid odX4 uiooi .moA •ui loauo jo otup it, pwinboi on piuj IipwD piles put, QI ologd V K)IOH •snduieo aaij 000egol e si jsioqu V sjjasniloesstW jo 44jSJ3niujl a1q1, i ana Ieioods `s,iepiloq ui lno uo Xldde ieui saaj IeuoijjppV •aaj Xouedn000 OJJU paniaoaz suoilellaoueD •leni.ue InOX 01 JOUd Xvp (1) ouo iseal it, ouii j, �3seald `uoilenjasa.i .inoX, loom of paau oqj pug noxi pinogS :uoiiuilaauva :uoiJoutoid :Isanba-d iuiaadS 1 uaapllgo p `(s)IInpeI :sisan-9 jo aaquunN OuixoLuS uoN spog algnoCI omZ :adAl woob 00.0 :;lsoda(3 aouenpd ZZ'£Lti :le;ol pueaE) (;u6iu jad wool aad eel 00- L$ pue ea j Aouednoop % g) ZZ -9Z :aaq Aouedn000 00'L8£ :;unowd le;ol woos we00:LL ino Noayo `%OZ/50/OL `AepsaupaM :aan:pedaa wd00:£ ui Noayo `%OZ/ZO/OL `Aepung :lenlaJy LZZ££L :aagwnu uol;ewiguoo I P VY Janopuy qIJo N;o uMol 9LOZ/Z/6 C) N N a rn C' C7 CD 0 o w oo w w O n' CD O, CO O ? 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C" oo uoa rH r H C °o ly G H C .fC� ry C B CD C x C H a -i m z• Ro w � = H H C7 H H a H o H H r CD CD m Z H N coo O 0 H O a 00 m CD H CD o 3 a CD x CD r .. CD CD CD a B CD o ° w o �• N 69 Ib G5 '�] 69 N P> d0 d QQ O CD O tA CD O CD O O CD O C C O .Oi•, O M O C) O VOi O O SID ro 0 `m9 H CDCLfi A b9 G9 G5 Os A 69 J 69 N [ r' rb O O A N 00 O O c ft T m eD � y 14 w b m c% O N O Ln b F O N W J f.A Q\ a 10415 Date ..��� ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...`....,%........ 4 ...................................................... has permission to performe.2 ..... ............ plumbingin the buildings of ............................................................................................. at ....................... ....... " No h Andover, Mass. Fee /410.!W .... Lic. No. PLUMBING INSPECTOR Check# Date. 3A/ .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that -� ' !! ?.... I.0—i .....k"�,�. :..................................................... 19 1 has permission for gas installation inthe buildings of,................................................................................................ .................. .....-....................�;! North ndoyer, Mass. Fee . S -:.U. Lic. No.'t ,a .�:.................:................................. GAS INSPECTOR Check # „ is 9132 G TYPE OR PRINT CLEARLY APPLIANCES 1 BOILER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY G MA DATE S PERMIT # JOBSITE ADDRESS "� Cts ' ✓� Kzj OWNER'S NAME OWNER ADDRESS C` r TE=reFAX OCCUPANCY TYPE COMMERCIA EDUCATIONAL ® RESIDENTIAL NEW: [] RENOVATION REPLACEMENT: FLOORS- I BSM 1 _L__L_L_3_j 4 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 UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES Q NOLJ 10 1 11 1 12 INSURANCE COVERAGE have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF CO RAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND FJ 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. mil W W FK CHECK ONE ONLY: OWNER E AGENT ED SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit all P rtinent provis' f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMELICENSE # o A SIGNAXRE MMGF 0 JP ® JGF LPGI CORPORATIONS#6� PARTNERSHIP ®#= LLC [3# COMPANY NAME: �G _ 1 ADDRESS --� CITY �✓"_ _ I STATE MZIP TEL FAX J CELLL _EMAIL �✓1 i Y �'_ r• •A .O O H U a L C ❑ z O jN ❑ W p vA O W O W = f- a a a o w > L LU U) a a, a U J F., a CL a � s w w U- W H O z 0 H U W O O r• •A The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations Uf 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation ]Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly � Name (Business/Organization/Individual): Address:_ ��/�y/�el�—�'�� City/State/Zip:_�i� !/✓� G�+ Phone #:%�'�c�% re u an employer? Check the appropriate box: . I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Elle .trical repairs or additions �RFFI lumbing repairs or additions oof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. _ _ Insurance Company N e Policy # or Self -ins. Lie. #: �i/ = s,/�a�� Expiration Date:. Job Site Address: Z�GL�, Ci� U City/State/Zip. l C Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date): Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert e the s anrlpenaX s ofperjury that the information provided abov is true and correct. 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 producedacceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston., MA 021 It TO, # 617-727-4900 ext 406 or z-877,MASSAFB Revised 5-26-05 Fax # 617727-7749 wwwanass,govfdla 04325 -FA MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PL MHING WORK ray JQN k11 O! __� MA DATE $ PERMIT# JOBSITE.ADDRESS,S® iMU '� OWNER'S NAME POWNER ADDRESS G�T'4 Pte/ TELc�EIFAX TYPE OR OCCUPANCY TYPE COMMERCIAL>& EDUCATIONAL 0 RESIDENTIAL D1 PRINT CLEARLY NEW: 0 RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES 0 NODI FIXTURES -1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _! .�.—I = = = = - l _�j _ -.-_ CROSS CONNECTION DEVICE �! _ ( [ __ __. -__._ 1 _.w__ _.___ E . —_.. — —% —w— DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM --- DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM i . _ _ _ —_.! _ .__.I I __.- I _-_-__! DEDICATED WATER RECYCLE SYSTEM DISHWASHER l ____._( __1 __._ ! ._ __� .__._� _ __ __._ I _.__.i ___� ____! 1 DRINKING FOUNTAIN __ I _..___-�---__-� _____f v___I _..__.___I _....___I FOOD DISPOSER FLOOR/ AREA DRAIN R _ l ___-_� ___ ► __ _.� __—i _...__.1 _ __1 _ ...__! ___.� .. _! __! _-._i_ I _____! INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY I _ - --.__A.__ -_--! -------11 ... .__.1 ROOF DRAIN 1 ___� SHOWER STALL I __._ ____ =J1 __..__ ( _._. ___ l __. __. J i _._( _ _ l ! SERVICE / MOP SINK TOILETL-j URINAL WASHING MACHINE CONNECTION -._.. __ ._-t WATER HEATER ALL TYPES WATER PIPING 1 I _--.. OTHER — _ INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YE�N NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 5 OTHER TYPE OF INDEMNITY Ej BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER R 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 compliance with all Pertinent pr ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I LICENSE # ®'!�� SIGNAT E MP JP CORPORATION�PARTNERSHIP#r— LLC COMPANY NAME Je4_ ADDRESS[ CITY ) STATE ZIP ��� TEL�tJ1 FAX ELL I EMAIL ij o ED z C, N ❑ loo The Commonwealth of Massachusetts " - Department of IndustriqlAccidints 07 Office of Investigations 600 Washington Street Boston, MA 02111 kvi www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anulicant Information Please Print Lep-ibly • Name (Busincss/Organization/lndividual): Address: City/State/Zi � Phone #:I Are you an employer? Check the appropriate box: Type of project (required): 1.am a employer with W 4. ❑ I 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. 7• El Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9• ❑ Building addition [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] 3. ❑ Z am a homeowner doing all work right of exemption per MGL 1 . lambing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance ] ired. re q u employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address:-�s�, G(J1Gt/7�J —,City/State/Zip.-A/, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er pains and p9haldes of perjury that the information provided abple /zs'true and correct Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - Contact Person: Phone Informati®n and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who,has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massach-use'tts aDepa ime,ut of 1ridustrial Accidents Office of Investigations 600 Washington Street Boston} MA, 02111 Tel, # 617-727-4900 eyt 406 or 1.-877-.NlASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia COMMONWEALTH OF MASSACHUSE ^ REGISTERED AS A_ PLUMBING CORi� ISSUES THE ABOVE LICENSE TO JOHN F_ BICKFORD MAJESTtiIC 'MECH CONT I -NC M'1'25D3� PO BOX 201 T.EWKSBURY MA 0'1876.0201 2229 05/01/14 142803 Date ....... r TOWN OF NORTH ANDOVER �-e APERMIT FOR WIRING This certifies that ............. C0�7042 .... ................................................................ . ......................... has permission to perform. /��Z;).P ........................................................................... wiring in the building of..../! �-r 15ny? &-, .............. at,.... ................................................................................................. /North Andover, Mass. Feel.:�,5�.. Lic. No.....( ............. .......................... ........... ............................... 33 9P�- ELECTRICAL INSPECTOR Check 12305 I Commonwealth of Massachusetts a Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 12-b n S— Occupancy and Fee Checked :ev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (IvIEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL ,INFORMATION) Date: -1. -4`Z, �- City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) COwne Dy TenantLcS.� Telephone No. �'l $- SSA, $�crr Owner's Address igs e !)ST :21T 'i'i ti.� f M A Is this permit in T conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Q Sin._ Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service IJAG Amps 12.6 / x e2 Volts Overhead Q Undgrd ❑ No. of Meters t Number of Feeders and Ampacity fy r„ 4 k 41 zLs r4-r—n -T itlp" Location and Nature of Proposed Electrical Work: V t , � �_ _ �a\ - f1�b z:;I,, I,- ` Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans s Total of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 2, Swimming Pool Above ❑In- 11 rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets 3 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices HeatPump Number No. of Self -Contained No. of Waste Dis osers P Totals: ,Tons I.KW Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal [_1 Other Connection No. of Dryers y Heating Appliances KW A Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs j Ballasts 2— Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wtres. Estimated Value of Electrical Work: 14_— (When required by municipal policy.) Work to Start: 4.2L-t—P-- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAG : 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 M BOND ❑ OTHER ❑ (Specify:) I certify, cinder the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Lp�mg gg. t=r,�TR c iaL S" Zi t -d LIC. NO.: f 7_S >s Licensee: G�jz 60zXp C *,i),A6 ti}, Signature9,,�� LIC. NO.: 4jw-AL (If applicable, enter "exempt" in the license number line) Bus. Tel. No.:'FZ$ • 4 Z K2 Address:WZ.. L l�'$�, 6'a�ZD� �"� �vs�Ll.`!M (� aL) Alt. Tel. No.: 52g -3tS—`7°t19 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE:.$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the q permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an *r electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he O or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: r S Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass❑' Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass V Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Y' Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Si ature: Date: ON DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com 'The Commonwealth ofMassachusetts lcxY Department oflndustriglAccidents Office of Investigations quo 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiv Name (Business/Organlyation/Individual): CSS Address: 182— City/State/Zip: c5t,s 1 Phone #: "n $, —f:2�3 3SZL 5�N Are you an employer? Check the appropriate box: Type of project (required): 1. UI am a employer with "sy 4. ❑ I am a general contractor and T 6. ❑New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner - have nedthe sub -contractors listed on the attached sheet. t �• remodeling ship and'have no employees These sub -contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance. 9. [J Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ 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.] i employees. [No workers' 13,0 Other i' comp. insurance required.] Mny applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. T Homeowners who submit this affidavit indicating they ice doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. . I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. Expiration Date:. Job Site Address: City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cero under the pains and penalties of perjury that the information provided above is true and correct. Signatures Official use only. Do not write in this area, to be completed by city or town offrcial. Cif 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 t•,. 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 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 retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance fox 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 Garnmo woalth ofMassacliuset€s Depaztmen t o f ftdustdal .A.ccidonts OfAce ofTu estigatio.�s 600 Washingtall Stroot Boston} MA, 021 Z Z TO, # 617-727-4900 eyt 406 or 1-87TMASS.AF Revised 5-26-05 Fax 617-727-7749 VV1WW.mace anV/j,'A r a �Is✓tom /r/ SG�i.L¢''/�� A loS- (.\ �Date.............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 5,1 4- , H Q- \'), I \ , '�' S ............................................................................................................ has permission to perform ........ . .......... .................. rforfn ... wiring in the building of... . 5�m ............................................. ...................................................... .................. -Iorny .../�Z- at ... . .... ca;z: .......... ........................ North Andover, Mass. Fee Lic. No. ............... ................. .......................... .............................. .. . ...... ... EL CTRICAL INSPECTORI KZ cjr) I Check # 351 10110111 �4 iii - Vii:: l (lam �,/�p�1��� Permit No. It Occupancy and Fee Checked ROAR. OF SRR PRFYQ 1,0N, EG—UL4 1QW .. �. 1/47.}- eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 D/,) 4�/1 y City or Town of: NORTH ANDOVER To the Inspector of Wires: By this, Vpli tions t-h@.undersoiedgiye notic@_of.l &or -hey inwatiop-t ape..dthg-elpa a workdf--vAhe_ �-- Location (Street & Number) , SU tv / }'I A yc /9 V Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No El(Check Appropriate Boz) reqnni�cra'i f 2 G i` rc *dW*=4bWPsM 4bW Existing ServiceAmps Volts Overhead LJUndgrd LJNo. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t`� d 04tS��y c rr��/ fj¢c rL cry Completion of the following table may be waived by the Inspector of wires. No. of Recessed Luminaires $ 6 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs GeneratorsA*eK No. ofLuminaires ``wimming Foof � .� ❑ rnd. rnd. �` - .3 Battery Units No. of Receptacle Outlets Sot No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches / p No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pump Totals: umber ons - � o o. o Set ntame Detection/Alerting Devices I No. of Dishwashers Space/Area Heating KW Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW meters No. o No. o Masts Data Wiring: No. of Revises or E tenr'`S No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wirmg: No. of Devices or Equivalent OTHER: V) 00 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ) o 00 (When required by municipal policy.) Work to Start: /6& ( /f c/ inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [Z BOND E] OTHER El(Specify:) 6e -R yrc I I certify, under the pains and penalties of/perjury, that the information on this application is true and complete FIRM NAME//: V�aui>? /'1c�(% �!la.,� S LIC. NO.: ZJf /-4 Licensee:Signature *7--, LIC. NO.: I -'sl J- (If applicable, enter :exempt" irr}} the license numberline) Bus. Tel. No.; 5-0 '%5:5S Address: /L /'d EKL2 1f UL t�CS ct/.�/!��/��'t ,,�'i 41 Alt. Tel. No.: s` r.-si 2 -rS *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ (� ac 10-31-11-1 P�'I 0,�,, C,,� eA- a4::f, 288 Date.(0 // TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION . a This certifies that ..��1.. ;rt/r�®' �?�• has permission for mechanical installation .. ��6(--.7 ............. in the buildings of )47—. .. ........................... . r• ..�./.�... ortyyhy�Andover, Mass, Fee. ✓.�i.... Lic. No. ��. .. + .. ........ ........... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date : O Estimated Job Cost: d� . Plans Submitted: YES NO Business License # 0 1 Permit # b2 Q Permit Fee: $ Plans Reviewed: YES o< NO Applicant License # 3 (10M7 Business Information: Property Owner / Job Location Information: Name:7_6rn y��U\ \ i�G Name: !::I Street: C5 �, i,� ;_� Street • Ce.� t City/Tow n:1P City/Town: /V - r Telephone: q Telephone: Q l �C Photo I.D. required / Copy of Photo I.D. attached: YES NSC Building Type: Residential: 1-2 family Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional. Building Cubic Footage: under 35,000 cu. ft.O!C over 35,000 cu. $. 1 Sheet metal work to be completed: New Work: Renovation HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: I ou L/ry-" CIF 1 Ltti r-_ t INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112Y No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance poll Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxEl, 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 sheet metal work and installations performed under the permit issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Progress Inspections Comments Final Inspection Date Comments By Type of License: ❑ Master ❑ Master -Restricted Title Cityrrown ❑Journeyperson Permit # ❑Joumeyperson-Restricted Fee $ Inspector Signature of Permit Approval Signature of Licensee License Number. Check at www.mass.govldpl Yes No Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) t Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper 6164ances, fire rated enclosures and pressure testing required: .Seis':aic res�zaint� installed Wli&d isquir I. 'oi� equipment apd Th.. .viii Duct penetrations in fir'e'rdte wall:q and floors sealed: Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean -properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0'; maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean -properly sized filtefr installed (final inspection) Testing and Balancing report complete (final sign -oft) D7V,.!wSION GC+ ��CENSJRE �.n of mss" I_' METAL w©R� L_. ST��tSTR::. 7F - ter_ '" m� 9 TEAMM-1 OP ID: SG ACORU' CERTIFICATE OF LIABILITY INSURANCE DA10/02/201 Y) 10/02/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Planright Insurance -Salem 224 Main Street Suite 3C Salem, NHADD James A Santonto CONTACT James A Santo PHONE FAX AIC No Ell: 603-890-6439 A/C No): 603-890-6521 RESS: Jamie@santoinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 07/22/2014 INSURERA:ACadia Insurance 31325 EACH OCCURRENCE $ 1,000,00 INSURED Team Mechanical LLC Walter DiGesse INSURER B: 820 Livingston Ste 9 INSURERC: INSURER D: Tewksbury, MA 01876 INSURER E: INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COVERAGES CERTIFICATE NUMBER: RFVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS'AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL U POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE TOCCUR BOA5112622-11 07/22/2014 09/26/2015 EACH OCCURRENCE $ 1,000,00 PAMAGE TO RENTED REMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ L AGGREGATE LIMIT APPLIES PER: JE� LOC M'OTHER: GENERAL AGGREGATE $ 2,000,00POLICY PRODUCTS-COMP/OPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea a.,.nt BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER' DAMAGE $ Per accident UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCA5112890-11 3A: MA 09/26/2014 09/26/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Walter DiGesse is excluded from workers compensation coverage. Town of North Andover 120 Main Street North Andover, MA 01845 111011JO' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Location 'SfD UN A6 -p 'ko- A T�T No. — - Date 1 1 i f Check # uaPV .23124 ,TOWN OF NORTH ANDOVER .Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee IS r.. TOTAL $ - Ii 136il� ng Inspector E -0 CD 5. 0 0 h 00 c 101 m Z D r F r c z m N Z m .o .00 m v <(n0 G)0 A) 0 O IUl =(a +0 c O (Q 0 o =r O m N N m °- -v° 0 53 D .+0 90N (� m 0 _ c 0 0 0 m ° I CDS Z N ;:I. O C/) =- (Q 0 7 : N Q. ---h to m m 0 CD 7 �' � o o cn o. o co 07 0 -a = < D o (. 0- �mG) (1) CL o v m CD r 0 CD 3 o m ° < - 90 W 0 � o m c �� = =r CD0 C7 N' 0- Q. CD cn -uCD aCD v m cnCD ' N N � O < (D h� cp (Q CD O Ocn CD (D cD 3 0 o' 0 cD cD 0 (Q� O Z 5J J O z 7 M _ Z v O m X r *** Tp� - ? b IJ::' A , o ��. Ate! . � • A O Z 5J J O z 7 M _ Z v O m X CD Co cs. 0 _w N 0 0 a, 11 0 b a- 0 0 CD y CD 0 �n CC 0 0 C Q: CD O I �, o �z 'CDo o ° o G —CD s CD'_o CD CD afD ° Co CL O ° CD CL t3 CD .� CSD CD v� o 0 � CD c':9D i aq 0 � o CD ts CD 0. CD w N � ° (DC°' _, CCD � 0 CD O.0 C CD DD m r"CD 0. a CD P� aq' rn .t n yO. 0 SD G a CL o CD CL CD CD O CD o �. CD 0 .r C) Ln i1 -' O CD `C3 a- = aq O `C CD CD '•o n n o d aq o CD �.o �o.oa� pCD,�� CD iu b 0 0 CL 0 0 K oCD W CD CD aro o ao � % t IP ._. 0 w F. a C CD 0 N v 6 0 0 w T N CD 0 �n b 0 rD a. C C. z 2 m z c m i A 0 m r D 90 0 m r D m D r- c W D C U) m O z cn Z 0 Deems, Maura From: Richard Crawford <rcmercer@verizon.net> Sent: Thursday, October 02, 2014 1:57 PM To: Deems, Maura Subject: RE: Sign Permit for AT&T Store Got it, thank you, will forward the balance. Rick Crawford Bartush Signs 215-345-1481 voice or fax From: Deems, Maura [mailto:mdeems@townofnorthandover.comj Sent: Thursday, October 02, 20141:52 PM To: rcmercer@verizon.net Subject: Sign Permit for AT&T Store Dear Mr. Crawford, We received the new sign permit for the AT&T store at 350 Winthrop Avenue in North Andover, MA. The cost of the sign permit is based on the cost of the job ($12.00 per thousand) or a minimum of $30.00. Based on your application the sign is to cost $17,000.00 so the fee would be $204.00. The check enclosed is for $60.00 so we would need an additional check in the amount of $144.00 in order to start the sign application process. Thank you, Maura Deems Building Department Assistant Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2035 North Andover, MA 01845 Phone 978.688.9545 Fax 978.688.9542 Email mdeems@townofnorthandover.com Web www.TownofNorthAndover.com t34{ C.ivS�� October 6, 2014 Town of North Andover Attn: Building Department 1600 Osgood Street North Andover, MA 01845 Dear Madam or Sir: Divisions of Bartush Signs: Hanisburg.PA RE: AT & T North Andover Mall North Andover, MA Enclosed please find a check in the amount of $144.00 for additional permit fees for the above -referenced job location. If you should have any questions or concerns, feel free to call our office. Sincerely, w . �M 0(/✓o'Y) Cheryl Mason Bartush Signs, Inc. Enclosure 302 North Washington Street • Orwigsburg, PA 17961 • (p) 570-366-2311 • (f) 570-366-8976 ACORO CERTIFICATE OF LIABILITY INSURANCE II, DATE (MNUDDIYY YY) I w 10/4/2014 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS, , CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to -the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AP INTEGO INSURANCE GROUP LLC 250846 P: F: PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: PHONE FAX (AIG No, Ext):(AIC. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICs INSURERA: Hartford Fire Ins Co INSURED KRYGOWSKI ELECTRIC, INC PO BOX 609 DUNSTABLE KA 01827 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, V SR TYPEOF X%1SURAAWE ADD SUER POLICTATUABER roacrFrF nrr POLICYF-VP LMIS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑ DAMAGERENTED PREMISES (OCCUR S(S Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG g POLICY PROEl LOC F JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DE RETENTION S S WORKERS COMPEA'SATION ANDEWLOYERS'L1481LITI' ANY PROPRIETOR/PARTNER/EXECUTIVEYIN X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1100,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) F1 7676 itiTE,G GA1281 10/13/2014 10/13/2015 E.LDISEASE- EAEMPLOYEE 5100, 000 If yes, describe under E.L. DISEASE -POLICY LIMIT "500, cj00r 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHIC'QMRD 101, Additional Remarks Schedule, maybe attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The Town of North Andover BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR2EDREPRESENrATM ` Attn: Peter Murphy/Electrical Inspector 1600 OSGOOD ST BLDG 20 STE 2035 7a-�— NORTH ANDOVER, MA 01845 ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AP INTEGO INSURANCE GROUP LLC f PO BOX 33015 -SAN ANTONIO TX 78265 MB 01 010282 90511 B 34 G Il��ll����ll�l�l�llll��ll�l��l�"���I'�'I�"II�III1�11�11�111�11� The Town of North Andover Attn: Peter Murphy/Electrical Inspector 1600 OSGOOD ST BLDG 20 STE 2035 NORTH ANDOVER MA 01845-1057 O ACORD 25 (2014101) September 24 2014 Town of North Andover Attn: Maura Deems Building Department 1600 Osgood Street North Andover, MA 01845 RE; Sign Application for AT&T Wireless Dear Ms. Deems: Enclosed is a Sign Permit application for AT&T in regard to the installation of a new wall sign at the North Andover Mall. I spoke with you more than a month ago about a sign application previously submitted back around May 1st 2014, which I understand was approved. AT&T decided to modify the design in the interim. Work on this Application: - install the new wall signage as shown on the plans, including the gooseneck lights; - install (2) inserts in the existing Freestanding tenant directory sign; Batten Brothers Signs is our local installer for this work: 893 Main Street Wakefield MA 01880 781-245-4800 We have enclosed the following for the Sign permit review: - Sign application + $60 fee (I believe you mentioned this fee) - (3) sets of sign plans showing sign design, the elevations and sign construction - (3) copies of the original sign plan Please let us know about any other information that may be required to obtain a permit and install the signs, and any fees, and we will forward them immediately. Sincerely, / 114 6� Richard B. Crawfor (215) 345-1481 voice or fax / rcmercer@verizon.net 302 N. 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V'^�....... ..... • • . has permission for mechanical installation 7.._} 4!,•.`�L\ in the buildings of ..� 1..�. 1-. �: L� ............... • • • • • • at ..`- t �•? - `''�(3• e- • • • • • • • , North Andover, Mass. Fee.?5� 3=�. Lic. No.. � lE.. j� .................... � GASINSPECTOR I �u 4 I �HITE: Applicant CANARY: Building Dept. PINK: Treasurer a TOWN OF NORTH ANDOVER 1600 OSGOOD STREET Building 20 Suite 2-36 NORTH ANDOVER MA 01845 FURNACES BOILERS ROOF TOP UNITS AIR CONDITIONERS EMERGENCY GENEREATORS Date: 05/06/2014 The undersigned applies for a permit to install the following at: Location AT&T 350 Winthrop Avenue 875 East Street Owner of premises Delta & Delta Realty Trust Address Tewksbury, MA 01876 1059 East Street Name of mechanic Commercial Comfort Service, Inc. Address Tewksbury, MA 01876 Building occupied for Retail Material of building Concrete block steel Kind of fuel Natural Gas Chimney No. Of flues Size_ Chimney Thickness Lining If steel stack location Diameter Height DESCRIPTION OF HEATING APPARATUS Kind of heater how many BTU Inpu Location in building Protected against fire as required How protected See the State Code (Pertaining to Chimneys, Smokestacks and Heating Apparatus) ROOF TOP UNITS OR EMERGENCY GENERATORS Make Carrier Weight 955# and 609# Dimension Length 88" Width 59" Height 42" Location of building 350 winthrop Avenue how supported on curb by bar joists Size of roof timbers see engineer's sketch Material of roof timbers Span of roof timbers Distance on center. Protected against fire as required How protected Kind of apparatus HVAC FORM REVISED 11.04 AIR CONDITIONS make CID BRANAGAN ENGINEERING, INC. 160 OLD DERBY ST., SUITE #335 HINGHAM, MA 02043 (,781) 749-5400 I ai C:\()RAW+NGS\14126 JOB: NEW ROOF TOP UNITS AT&T 350 WINTHROP AVE. NORTH ANDOVER, MASSACHUSETTS DATE: MAY 2, 2014 SKETCH NO. SK -1 EXTERIOR WALL 17-1 + NEW L4x4x1/4 UNDER CURB, ' (TYP.) VERIFY RTU LOCATION WITH MECH'L. OWGS. ; ------ I --------I ------- --- -- 41 + NEW RTU 2 I I I W T.=60 � .-.I — I-- -------- - ' -- ----- I ----- I i--4 1 + I I ( �--CMU BRG. WALL I I A i 1 + Q+ I IU Ln I W I , , m' I _ 1, H 04 i I I WILL' + I I I I I U I N i NEW L4x4x1/4 UNDER CURB, + I) w I (TYP.) VERIFFYY RTU LOCATION + WITH MECH L. DWGS. 3I I , I I + i + I I II 1 I I !-------, 1 + NtW RTU 1 I I G 13 I i WCT.=955# I !--------I --- --s--------- , I I I 1 1 1 PARTAI L EXISTING I.� :. �l �1���:11e.�lvpY ROOF FRAMING PLAN' ' SCALE: 1/8-=l'-0- NOTES /8 =1'-0N T Y 1.) SEE SK -2 FOR "NOTES" AND "TYPICAL DETAILS".� BRANAGAN ENGINEERING. INC. 160 OLD DERBY ST., SUITE #335 HINGHAM, MA 02043 (781) 749-5400 3/16 FRAME ANGLES - SEE PLAN JOB: NEW ROOF TOP UNITS AT&T 350 WINTHROP AVE. NORTH ANDOVER, MASSACHUSETTS DATE: MAY 2. 2014 SKETCH NO. SK -2 FITTED PLATE 3x3x 1 /4 NEW 2—L1 1/2x1 1/2x3/16 SLOPING STRUTS. FIELD WELD. 1 FITTED PLATE I 3x3x1/4 I ( FRAME ANGLES, � TIGHT TO ROOF I ' I DECK. �. 1/8 SLOPING STRUTS. `\ JOIST (SEE DETAIL JOIST I I AT RIGHT) TYPICAL DETAIL AT ROOF FRAME_ SUPPORT ONTO JOIST NOTES: NOT TO SCALE 1.) INSTALL FRAMING L4x4x1/4 UNDER CURBS OF RTU AND UNDER CUT EDGES OF ROOF DECK. SUPPORT FRAMES ONTO EXISTING JOISTS. 2.) WELDING TO JOISTS TO BE DONE WITH E7018, LOW—HYDROGEN ELECTRODES WITH 1/8" RODS, USING LOWEST PRACTICAL AMPERAGE. NOTES GENERAL 1. The Contractor shall verify oil existing and new dimensions and conditions at the site and report any discrepancies to the Architect before ordering material and proceeding with the work. 2. All work shall conform to the requirements of the 2009 International Building Code with Massachusetts Amendments. 3. All sections, details, notes, methods, or materials shown and/or noted on any plan, section or elevation shall apply to all other similar locations unless otherwise noted. 4. Existing structural members shall not be cut, removed or altered unless the Contractor has verified existing/new support conditions for adequacy and has notified the Architect of any discrepancy. 5. The Contractor shall shore and/or underpin existing work as required to safely install new work. This work shall be the full responsibility of the Contractor and no act direction or review of any system or method by the Architect shall change or effect the Contractor's responsibility. WHEN R.T.U. LOADS DO NOT OCCUR AT A PANEL POINT, STRUTS SHALL BE PROVIDED AND INSTALLED IN THE FIELD TO CARRY THE LOAD TO AN OPPOSITE PANEL POINT AS SHOWN. TYP. JOIST DETAIL UNDER R.T.U. NOT TO SCALE STRUCTURAL STEEL 1. Structural steel shall conform to the requirements of the American Institute of Steel Construction. Material ASTM—A36. Submit shop drawings for review by the Architect. 2. Welding shall comply with the requirements of the American Welding Society AWS D1.1. Use E70 series electrodes. C:\DRAWINGS\14126 ARorCERTIFICATE OF LIABILITY INSURANCE DATE 5/6/2014Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Tonry Northwest Insurance Agency, Inc. 238 Bedford Street Lexington MA 02420 CONTACT Patricia Ca adanno NAME: P PHONE (781) 861-18001440, Ext), FAX No,, (781)861-1804 ADDRESS: Pcapadanno@tonrynw.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Harle sville Insurance 23582 INSURED Commercial Comfort Service Inc. 1059 East Street Tewksbury MA 81876 INSURER B :Harle sville Worcester Ins Co 26182 INSURER C AmGUARD Insurance Company 42390 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:CL1422007991 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BE DELIVERED IN TYPE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP M IDDIYGENERAL LIMITS LIABILITY AUTHORIZED REPRESENTATIVE North Andover, MA 01845 L Tonry Jr./PCAPAD EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,000 rLR X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR SPP00000029087Q 2/22/2014 2/22/2015 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: -X1 PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BA00000029086Q 2/22/2014 /22/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X HIRED AUTOS X NON -OWNED AUTOS PIP -Basic $ 8,000 X X UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAB DED I I RETENTION $ 00000029085Q 2/22/2019 /22/2015 C WORKERS COMPENSATIONx AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) N/A COWC578342 /22/2014 2/22/2015 VUCSTAT11 OTH- I EI E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes. descnbe under DESCRIPTION OF OPERATIONS belmv E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is an Additional Insured, when required by written contact, but only to the extent provided in the Additional Insured endorsement(s) attached to the policy, a copy of which is available upon request. Where permitted by state law, the Insurer waives its rights to subrogate against the Certificate Holder, but only under the circumstances stated in the policy. CFRTIFIrATP NOI nFR CONCFI I ATION ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn75 oninn,ln1 Tha arnpin nnma anri Inn^ ora ranla4arari mark¢ of ar npin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of North Andover 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 L Tonry Jr./PCAPAD ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn75 oninn,ln1 Tha arnpin nnma anri Inn^ ora ranla4arari mark¢ of ar npin LICENSE NUMBER 'EXPIRATION DATE: a SERIAL' -NUMBER AT 4 T S6w-Q- LocatioC);37--(jn��y �i t�-�� ���A�/� No. . 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