Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 522 CHICKERING ROAD 4/30/2018 (2)
522 CHICKERING ROAD \ 2101071.0-0015-0000.0 J 1 t� { it I�I I iIII I II I� Date...J.:.2....... v..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SS^CMUSEt This certifies that ..................A., .................... . .............................. has permission to perform ....5 .......... wiring in the building of.... ...... ...... at.......6-2-2- (2,6r4-,q ...... .................................. .... o. Porth Andover,Mass. Fee ... Lic.No. ............. V ELECMCAL IMPEC R 322 'Check # 9264 Date.. �Z....���... .i t NORTH 1 :;•' `" "°off TOWN OF NORTH ANDOVER o PERMIT FOR WIRING C SACNU This certifies that ..... ......... ............... 5. :��.......7 ........................ has permission to perform .. .................... ..........�.......... ..........r.:........ wiring in the building of..........................L.v............................................. at F,Z- �'y��E2! ......�b. ,North Andover,Mass. t Fee..� ....Lic.No. .O 0 88 6. t .... 1.. ....... ... .. ........ ..... !" C'!:�/7.C.� ��!r.. ELECTRICAL INSPECTOR Check # 7� 9394 Commonwealth of Massachusetts official Use only Department of Fire Services Permit No. _ '�_3 17 1/ BOARD OF FIRE IFPREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 eave bl APPLICATION FOR PERMIT TO PERFORM ° ank All work to be performed in accordance with the Massachusetts ElectricCELECTRICA ELECTRICAL (PLEASE PRINTININK OR TYPE ALL NFO RMA Date: 5 � ,p City or Town of: NORTH ANDOVER BY this application the under-signed ed To the Inspector o Wires: gn gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Q Id Owner or Tenant �!t U Telephone N Owner's Address oC.f $ �SoNJ9'T' � Is this permit in conjunction with a building permit? ye O✓�E NO ❑ Purpose of Building (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: &ZOCA7E w.4Li-6iLid, / SaP, i�6/yId✓E 1,9ZALL.L164rl ovER fVM<j1\,ra.: 3 �o� B a w,41-C.a- 7._ Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Sus o.of p.(Paddle)Fans Transformers Total No.of Luminaire Outlets No.of Hot Tubs �A Generators KVA No.of Luminaires Swimming pool Above ❑ .In- o.o mergency ig g , ❑ ttUnits -- No.of Receptacle Outlets No. of Oil Burdd. Bae ners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of RangesInitiatin Devices No.of Air Con11 d. Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number Tons KW Totals - o.of Se -Contained : - `� "` Deteetion/Alertin Devices No.of Dishwashers Space/Area Heating KW• Local Municipal❑ Otho Conn ❑ Other No.of Dryers g�� A Connection Heating Appliances KW Security Systems:* o,of water Noof No.of Devices or E ...val . ent Heaters KW No.of Data Whin Si s Ballasts. No.Hydromassage Bathtubs No.of Devices or E uivalent g No.of Motors Total Hp elecommumcations Wiring: II OTHER: No.of Devices or E uivalent Attach additional detail if desi Estimated Value of Electrical Work: red, or as required by the Inspector of Wires. Work to Start (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived b the licensee y the owner,no permit for the performance of electrical work may issue unless Provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The undersigned certifies that such c97BOND a is in force,and has exhibited proof of same to the e CHECK ONE: INSURANCE EDOT R P rmit issuing office. I certify,under the pains and penalties of perjury,that the ❑ (Specify') information on this application is true and complete- FIRM NAME: AM � Licensee: me, LIC.NO.: � (If Signature applicable, enter exempt"to the lic nse number line.) LIC.NO.: Address: Vt/ 0r. % Bus.Tel.No.: ��- /. Per M.G.L c. 147,s.57-61,security work requires D I�� Alt:Tel.No.:97R- o. OWNER'S INSURANCE WAIVER: I am aware that tthhe Licens a does noSaft havty 1e,the liability insuranceLicense: Lic.lcovera ally required by law. By m signature be e Y gn low,I hereby waive this requirement. I am the(check one) El owner ❑owner's Signature Telephone No. PERMIT FEE. S i � a I i .. � � �- ��� � ����� The Commonwealth of Massachusetts Department of Industrial Accidents Office oflrnvestigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): k Address: City/State/Zip:_ [CW[� S/� !B Y Phone#: 9176—oo'51, ' Id 3 Are you an employer?Check the appropriate box: 1.❑ I am a employer with 0 4. Type of project(required): ❑ I am a general contractor and I 6. ❑New construction loyees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner listed on the attached sheet. 1 7• [—remodeling * ship and have no employees These sub=contractors have 8. E]Demolition working forme in any capacity. workers' comp.insurance. [No workers' comp.insurance 5. 9 Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.]t employees. [No workers' 12.0 Roof repairs comp,insurance required] 13.❑Other `Any aplicaitt that checks box#1 must also 01 out the section bel^w shoving t: compm—sation,policy information. t Homem-mems who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractor;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 employee& Below is the policy and job site information. Insurance Company Name: A 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 required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine u to p $1,500.00 and/or one-year im rtsonmen as w p t, 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 her un rhe s d enalti s of perjury that the information provided above is it a and correct Si ature: i p�.��g�- Date.: Ul' l off- IO Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be`,resumed to the city or town that the application for the pernait 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 homeowner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.,a dog license or permit to bum leaves etc.)said person is 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 Departments address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 east 406 or 1-877-MASSAFE Revised 5-26-OS Fax#617-727-7749 vmrw.mass.gov/dia \amu„u„c,i�+etc�6,� v/ „�r:.ae ac,Lw e6ta � .,�• � _+ (�/\ Permit No. 7 ..Llehrrtment o1Jc]ire Serviced BOARD OF FIRE' PREVENTION REGULATIONS Occupancy and Fee Checked - • (Rev. 1/071 (leave blank) 49,61 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ov All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7.CMPy 12.00 r Z (PLEASE PRI,VT IN 1 K OR T)PE ALL LVFOR MTIOA9 Date: Ci t� o r Town of: 4Nt6o ac- r . To the Inspector of Wines: ` .8v this application the undersigned elves notice of his or herFintention to perform the electrical work described below. -Location,(Strect & Number, "a,-A, Cktc.Ge�e't ' Owner or Tenant ' �Lt-t /� °-�S ter It 4 Telephone No. �-f�� Owner's Address Is this permit in conjunction with a building permit? Yes ElNo ® (Check Appropriate Box) Purpose o f Building Utility Authorization No. Existing Sc' ice :imps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps J Volts Overhead ❑ Undgrd ❑ No. ofNfeters Number of(Feeders and Ampacity Location and Nature of Proposed Electrical Work: f Com lerion of the(onoble mai•be waived Lv the Inspector olft'ires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers Total Transformers KV.4 No. of Lumihaire Outlets No_of Hot Tubs Generators I<VA No. of Luminaires IS�iimming Pool Above EJIn- ❑ o. o mergency tg ung Qrnd. �rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of zones No. of Switches No. of Gas Burners . ho. of Detection and Tota_ Initiating Devices No. of Ranges) No. of Air Cond. Tons! No. of Alerting Devices No. of Waste Disposers Heat Pump .Number Tons k11' O. of Self- ontained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ MEl-other unicipal Connection No. of Dryers Heating Appliances K�`r eeurity Svstems:* No.of bevices or Equivalent No. of!Vater 1C�� No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage BathtubsNo. of Motors Total IIP Telecommunications Wiring: 4 '+ No. of Devices or C uivalent r OTHER: /044/700z) Attach addit!ono!derail if desired, or as required by the Inspector of l i'ires. Estimated Value of Electrical Work: aq (When required by municipal policy.) Work to Start: 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 ® BOND OTHER S eci Self Ins ❑ ❑ ( p fy ) ured I certify, under the j5ains and penalties of perjure, that 1lre irrf rmafion on this applicaliorr is true and complete. FIR M DAME: ADT Securit„, Services LIC. NO.: C ' �S Licensee: Marl-, ,,A . Brophy _ Signature Cv _ LIC. NO.: C-45 (If aaplicoblc, ewe, "erennpr"in rite lice,ise rnunibcr li,ne.l AddF-e'ss: 18,Clir_ton Drive I;ollis NH Bus. Tel. No.% 603-594 5928 Alt. Tel. No.:__ *Per M. G L. c.=147, s:57-61, security work requires Depar,mcnt of Public Safet "S"License: Lic.No. 00953 0WNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. Ba' my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑owner's agent. Owner/Agent Signature N Telephone [P.E-RMITp o FEE, $ Ll S - i�1? 1! Ic e�,artment of �eicSafety -,, oneAA burton P• • st S� � lace Rm. 1301 ��� � . .. • Boston, .M a .02 108 1618 Lice n-,r; S-Lirlinse Number: SSCC 000053 . it —..--- --_. Expires: /071 .:•-- _ - 2 201 1 ._... - -' - f r,.._-• ,-.:•• � ,Rostric(od To: 00 MAW( A DROP HY SR NORWOCO, MA 02062 no: 117.0 Kuep lop for rocelpl and ch,yn0e of)ddro:s ncllflcalion, �.— I ir•:' •A1 O noM•napv.pp.;lJFI�+AC/�OO:lwuy J � ' MIAIIT14ENT OF PUBLIC SAFETY vu, Nurniit $ CG 000'053 1 Tr. no: )17,0 . ��anl` CURITY SF>;vl f Commba�on�t '! DIG 5AFF_ CAI.L CCNTER:,, (080) COMMONWEAL-0F, MASSACHUSETTS .� _ � • � ' ���I►lT�'l.�;l�T1 Vii" . o0ARD OF.ELEC'rR!C!ANS, F ;. ' REC!S-TER-C9 SYSTEM CONTRACTOR " ISSUES 7)I'1 LICENSE TO 7Y E A))-f- � E.CUI, ITY SERi`V` IC.ES ; INC . HARK A '- ekOPHY - SR1 _ C .. • ' I 'N0RSE . ST HORWOOD ": HA 02062 - 4602' - j X53795 rIS 07/31/1T) 1537 ° 5 . f0d,In— O lu\1l:apAlfia,i::h�� i TBE C'OAMOW ILMOFMS94C'HUS' +;ITS Office Use only DEPA�NTOFPUBLICSAMY V �2 3'1 �!'. Permit No. BOARDOF527CMRI2.-W Occupancy&Fees Checked 4 . APPLICATIONFOR PERMIT TO PERMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH Tr MASSAC T STS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN;INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical worAdes bed Pelow. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No Q (Check Appropriate Box) , Utility Purpose of Building j Y Authorization No. Existing Service � Amps / .Volts OverheadUnderground No. of Meters Service Ams / Volts Overhead Underground No.of Meters New Ser Amps � g � Number of Feeders and;Ampacity Location and Nature of Proposed Electrical Work 7 et z-/SDC C wed(1{ aCc 116 No.of Lighting Outlets /jl No.of Hot Tubs No.of Transformers Total C V KVA No.of Lighting Fixtures Swimming'Pool Above Below Generators KVA round ground No.of Receptacle Outlets D No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners Z es No.of Air Cond. Total FIRE ALARMS No.of ZonesTons sals No.of Heat Total Total No_of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Np.of Sounding Devices Na ofSelf Contained Del&ti(on/Sounding Devices r Heating Devices KW Local Municipal Other Connections F Heaters KW No.of No.of Signs Bailasis i assage Tubs No.of Motors Total HP i I i Puts =tottrm tma)mZofMamwhlscZG=alLaWS Ilabihtyhmtuanoe�blicyinchx3ingComplei Covaageoritssubstddeg ivalart YES NO vandptoofofsametothe0ffiM YES Fq) IfynuhaNedEckedYES,pleaseindcatethe rypeofcowaageby, X. BOND 01IHQZ (Please Specify) B#alionDale Fslnnated Value of EkcWCal WOtk$ h>SpearonDaleRapested Rough Final � Per&esofpajMY- ' Lio=No. 1 c iyl W F INI Amdf!'JSignahnE1&t a4k7 Lic=No k b �� Busirm Tel No. -o� —;I t lr"I rF' V L e t + AltTel.No. 7on CEWAIVEI2 Iamawatethatthelicaedoesnothavetheir%uan�mvaageoritsat nalegtnvalentastequaedbyMassac.�hu&ZGfferall-ahispermtapplicadonwaives(hisiogmerrM?lease c eOwner' ® Agent ' Telephone No. PERMIT FEE$C Signature ot Owner or Agent - i i NFA b: G�rt , w 2F-s 7-6 I?Z-7�1c' r 3 i i NORTH q *6E 0 0 � ~yy t �YY T _ T �e ��SSACHUS�i�� TOWN OF NORTH ANDOVER Sign Permit Date: March 12,-2008 Permit Number: 028-2008 THIS CERTIFIES THAT Pauline Lee Has permission to erect a 5T'.X 40"Externally PrQjeclion Sigh _ On 522 Chickering Road __ provided that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit INTERNAL ILLUMINATED SIGNS ARE PROHIBITED 77 or of Buildings � Location No. -M cell Date 1 /C I NaR,h TOWN OF NORTH ANDOVER 4 i Certificate of Occupancy $ ." Building/Frame Permit Fee $ s�cMust Foundation Permit Fee $ Other Permit Fee, $ ` ' TOTAL $ ' Check # -1"37 2010 / G Building Insp&6r w SIGN PERMIT APPLICATION w 1600 Osgood Street Building 20, Suite 2-36 TOWN OF NORTH ANDOVER Site Owner Applicant Tel 979. 37-2-. 37a/ Site Address 5-d2 CA c.k. jnq f oo—eK, Size of Proposed Sign 4f � x J/ May Parcel Illumination: a)Not illuminated b) Internally illuminated How attached: a) Against the wall c) Extern y illuminated J b)Roof c) Ground Materials: Fa A it- &t r w PSV jgt2c.,oK.." d) Other Proposed Colors: Background Lettering wd.;V'- Cost of Sign Border Note: No permanent/temporary sign shall be erected, or enlarged until an Required Attachments: application on the appropriate form furnished by the Sign Office has been -Photographs of building filed with the Sign Officer containing such information including Material sample photographs, plans and scale drawings, as he may require, and a permit Color sample for such erection,alteration, or enlargement has been issued by him. Site or Plot Plan (Required for all free-standing signs) Such permit shall be issued only of the Sign Officer determines that the .drawings of proposed sign sign complies or will comply with all applicable provisions of the By- Other, specify Law. Will sign overhang any public road or walkway Yes ( ) No If Yes,Name of Agency who will provide liability insurance: / AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED//- DATE CCEPTED `DATE FILED: '3 "�/_U g Receipt# Check# /U Revised 10.31.2006 Form Sign Permit Application SIGNATURE OF APPLICANT Pauline B. Lu 522 Chickering Road North Andover,MA o1845 Town of North Andover Building Department 1600 Osgood Street North Andover,MA o1845 7 March 2oo8 To whom it may concern: As the property owner of 522 Chickering Road North Andover,MA o1845 I have reviewed and approved the proposed sign designs for this location. 1, Pauline B.Lu,the undersigned,hereby authorize The Sign Center to act on our behalf in all manners relating to the application of sign permits for 522 Chickering Road, including signing of all documents relating to these matters. Any and all acts carried out by The Sign Center on our behalf shall have the same affect as acts of our own. Thank you, Pauline B.Lu i I ACO&D CERTIFICATE OF LIABILITY INSURANCE OPID V DATE(MM/DD/YYW) INSIG-1 12/14/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE TD Banknorth Ins Agcy Inc (SF) HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 9040 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield MA 01101-9040 Phone: 413-781-59140 Fax:413-733-7722 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Company 25658 INSURER B: Technology Insurance Company 42376 DBA The Sign Center Insignia Inc INSURER C: TRAVELERS COMPANIES 18674 40 Orchard Street INSURER D: Nat'l Union Fire Pittsburgh PA 19445 Haverhill MA 01830 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR rUU SR POLICY TYPE OF INSURANCE POLICY NUMBER DATE MM/DDm DATE MM/DD/YY EXPIRATIONE POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1_000000 C X COMMERCIAL GENERAL LIABILITY 6605858C38A 12/12/07 12/12/08 PREMISES Eaoccurence $ 100000 CLAIMS MAdE a OCCUR MED EXP(Any one person) $ 10000 PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $20 00 00 0 POLICY 7 PRO- JECT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO BA8642C340 12/12/07 12/12/08 (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 D T OCCUR F7 CLAIMSMADE EBU3948704 12/12/07 12/12/08 AGGREGATE s5,000,000 DEDUCTIBLE $ X RETENTION $10 000 $ WORKERS COMPENSATION AND TORY LIMITA I S JOTH ER B EMPLOYERS'LIABILITY TWC3124578 12/12/07 12/12/08 E.L.EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE•EA EMPLOYEE $ 500000 Ifyes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS To provide evidence of insurance. CERTIFICATE HOLDER CANCELLATION GENERIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Itisignia, i Inc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL dba The Sign Center IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 40 Orchard Street Haverhill MA 01830 REPRESENTATIVES. IAUTHORIZED REPRESENTATIVE TD Banknorth Ins. Agency, Inc. ACORD 26(2001/08) ©ACORD CORPORATION 1988 r f z r `y ;. '. -wry David" Lu date 4 Match 2008 522 Chickering Road file. name 522 Chickering Road tarojection sign vt.plt THE ce North Andover, A size " x ` � Sq ftp .��, n,4v�t Asa, vr �".,�, , Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 11 March 2008 Enclosed please find a sign permit application for our client Pauline Lu at 522 Chickering Road. We are requesting a permit for the purpose of installing a new projection sign at this location. The support materials required for this process are also enclosed including a completed application, Workman's Compensation certificate, drawing of the proposed sign superimposed on a photograph of the existing building and check in the amount of$30 for the permit fee. If you find any part of this application incomplete please call me and I will be happy to send you additional information. I appreciate your help with this project, and if you have any questions or concerns regarding this project please call me at 978.372.3721. Thank you, Carla Marie Ciampa www.thesigncenter.com 40 Orchard Street Haverhill, MA 01830 978.372.3721 THE SIGN CENTER 10037 TOWN OF NORTH ANDOVER 3/7/2008 522 CHICKERING ROAD 30.00 I I I Cash; Banknorth NA- 522 CHICKERING ROAD 30.00 Date. 01 ".O RT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� . This certifies that . . . .-�:-C . � . �: A71 . . has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of . ;r. . . ! ... . . . . . . . . . . . . . . . . . . . . . . . . . .,... . . . . . at. .�.�.�"j '' � ==�-�:�'. . :�-�; North Andover, Mass. Fee.?l . . . . .Lic. No.. . . . . . . . . .`, . . . . .f� ./. . . . . . . . . . . . . . . PwM81f�f�i INSPECTOR Check .7 Lly az 55 ; 8 I J ! MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location v �( !� i r��,f�n� Owners Name n �C-� Permit# Amount Type of Occupancy C v pin? acs i New Renovation Replacement ❑ Plans Submitted Yes No FIXTURES r H � .� H O w �z! U a o o � C 3 H as SOMME &1 AEW HIM M MOOR OOR �FL" 4IH HDM 5M)HIDM 6M HDOR 7II3 HH " a SIH HDOR (Print or type) "' Check one: Certificate Installing Company Name '/ f Corp. Address ��' , � C r� '�` Partner. Busmess Te ep one ,�I - - 3 ��,� rD/Firrnt/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insuranc coverage by checking the appropriate box: Liability insurance policy Other type of indemnityElBond Insurance Waiver:.I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbin Code and Chapter 142 of the General Laws. By: Sig i m a 09 — Type of Plumbing License Title City/Townicense um er Master ❑ Journeyman VP .APPROVED(OFFICE USE ONLY Location • No. Date l r 01 40RTN TOWN OF NORTH ANDOVER to 9 # # • � ; , Certificate of Occupancy $ cHus Eta' Building/Frame Permit Fee $ a) s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ &v Check # r 6 C', 5 13 \ X-Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICxxATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING y,J 'a^� ..Y m<'v'aiw.• @ &`alb` �;, tt'�. ir9Y ,�`,,-_ BUILDING PERMIT NUMBER: 5-- DATE ISSUED: /O 9,! 63 ic SIGNATURE: �- Buildin Commissiomimefor of Buildings Date Z SECTION 1-SITE.INFORMATION o 1.1 Property Address: pp 1.2 Assessors Map and Parcel Number: L2 C�1(' 8l{ h-� 9 Map Number Parcel Number 1I\. 1.3 Zoning Information: 1.4 Property Dimensions: V` Zoning Diaiic—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Hood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes NO 2.1 Owner of Record Q �- Z 1kZCLe&k vt Q Name(Print) p Address for Service: Signature Telephone i 2.2 Owner of Record: a Name Print Address for Service: z rn Ai ature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 1.1 Licens�e�d� ruConstruction Supervisor: Not Applicable ❑ SC-ej" Jli i BOARO`OF Bt11LDItG FEGULATIONS treensa CONS TRUCTION'SIJPERvSOR" 9+lurriber 'C 084`402: i hf BuCFldate 06124/1:969 ,�•:;, ` ' Ea pins �;06/2472006 Tr no:.°84102 Restirrcted:`•00: 1 SCOTT T SICA 234 ESSEX ST SAUGUS, MA 01996 Ad' inistratbr II II e a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: la'f+T V=- Location: CLocation: tZt K Ci Phone # 7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name. Address Civ Phone*, Insurance.Co. Policy# Company name: Address Chir: Phone* Insurance.Co.- Policy•# Failure to secure coverage as required under See ion 25A or ML.15i2 can lead to fto of criminal per.of a fbe to to$1. andfor one years'm pmonment.as wetLas_cb 4aenatties inlheSnrm-da-7DP -afine-af-(sfmm)a understand that copy of this statement may forwarded to the office of investigations of the DIA for coverage verificatiorr. n , t do hereby under the . s and na of perjury that the inf+armebw provided above a true and comecct. Signature Date g 03 Print name 1 Phone-#2AL 09-o Aq 8 official use only do not write in this area to be completed by city or town dfidar City or Town Peer*Ajcensin4. Building De; C]Check if immediate response is requked Licensing Bo Selectman's Contact person: Phone#. Health Depot Other i NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-954 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S. 150 A. The debris will be disposed of in: (Location of Facility) I Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector i i I i Sica's Home Improvements CONTRACT Custom Home Renovations. 234 Essex Street DATE: 7123/03 Saugus,MA 01906 Office: (781)558-1700 Fax: (781) 558-1701 Mobile: (781)2 W30 Planned Start Date: Monday, September 2003 e-mail: scottsica@usa.Com MA Reg. # 135367 - MA Lic. #084402 Approximate Completion Date: 10/30/03 I To: Daytime Phone: 978-851-7253 Customer Name: Dr Stephen Lu& Pauline Lu Estimated By: Scott Sica Customer Address: 522 Chickering Rd Approximate Time 30-40 calander days City/Town: N. Andover To Job Completion:Location: Same State: MA Zip: Job Phone: 978-961-5557 PAYMENT TERMS: $5,000.00 down payment with this signedned con tract prior to start of work. 33/ of balance O)is due upon start of work. 33/ merit of 8910.00 dueu on rough inspection. Balance of$8910.00 and any outstanding fees(permit fees and/or additional work as outlined on page 2)due upon completion. JOB DESCRIPTION NOTE: For purposes for this contract and job description,all actual dimentions, area(s)and square footage are noted on the Plans as provided by Pauline Lu&Benco Dental Co..All work will be completed in a manner to accgmplish the overall intentions of the plan specification. 1. Wall between existing Dental office and new proposed space will be opened and a new threashold will be custom built. 2. Two(2)trenches will be cut(1 @ 26', 1 @ 16') into the existing concrete slab floor. Trenches will be appx. 18"wide and 20" deep. Trenches are to accommodate new plumbing&electrical services that will be located at the base of each of the three future Dental chairs. All debris will be removed from the job site. 3. Each of the three new operatory rooms will have a(one) new sink installed with white cabinettes and formica countertop(countertop color yet to be determined). Two of the new operatory rooms will have one additional cabinette array with both base and wall-mounted cabinette. All cabinettes&countertops will be of the same make and color. 4. Walls will be constructed for operatory room#4, the new private office and the Panoramic X-ray room. Walls will be removed and rebuilt in the bathroom and in operatory room#5 as noted in the plans as stated in the above note. One(1) pivit door with lockset will be installed for the new private office entry. 5. Wall areas for x-ray mounting blocks(3)will be custom fit into existing walls as noted in the plans and Benco supplied templates. 6. All Electrical work(materials&estimated labor)as noted in the plans is included in this cost projection. 7. Repair to any walls and any new walls will be constructed with Steel studs and 5/8" Fire code sheetrock materials. Plaster work is included in this cost projection. Items NOT included in this cost prosection but are available at additional costs (a) Floor covering(tile or carpeting) has not been determined. (b) Plumbing work(labor and material)including sinks&faucets. (c) Painting,wallpaper or other interior wall finish. (d) Please read terms and conditions on page two for any possible additional items not already noted. I "TOTAL JOB COST $32,000.00 *Pri includes MA, ** �e ate Sales Taxon Materials. Note: Please ** read terms and conditions on Page 2. i TERMS&CONDITIONS Page 2. 1. This contract&job description is for completing the job as described above. It is based on our evaluation and does not include building permit fees, Sub-contrators—unless noted above (electrical, plumbing, etc.) material price increases or additional labor and/or materials which may be required should unforeseen problems arise and/or customer requests changes in work design, materials or additional work is added(projects not included in the above job description)after the work has started. Architechtural design fees are not included in this job cost. All additional work or work changes must be made and mutually agreed upon, in writing. 2. Customer has three (3) business days from the below execution date of this contract to cancel this agreement after which the Customer understands and agrees to be bound to the payment terms and schedule of work. In the event that the customer(Customer)wishes to terminate the project (request for work termination MUST be presented in writing), it is hereby understood that all deposits and payments (installments) received up to the.time of the request for work termination, are non-refundable. 3. No work,shall begin prior to the signing of this contract and initial deposit is received. 4. Customer will allow a sign to be placed and displayed at the job location from the start of the project and for a period of not longer than 2 weeks after work has been completed. 5. Satisfaction Guarantee: Sica's Home Improvements takes great pride in all workmanship&the resulting work product(s). It is recognized and understood that the nature of this work is custom and subjective in nature. Every effort will be made to ensure that all work is completed to the exact specifications of the Customer. In the event that a specific result does not meet the satisfaction of the Customer and changes to the work are requested by the Customer, both the Customer and Scott Sica will jointly-determine and mutually agree upon the changes&the best resolve in writing. This may or may not be at an additional cost to the Customer, based on the scope.of said possible changes. (Note: The plans specifications will be executed. This (item 5)would be based more on cosmetic details). 6. It is hereby understood that customer will hold Sica's Home Improvements, Scott Sica and agent of, harmless regarding the completion of the project, based on the above estimated time to start and complete the above project, due to any unforeseeable delays. Z. This is the complete and entire agreement between the Customer and Sica's Home Improvements. By signing below both parties have read the entire contract and agree to all work, materials, payments, fees&terms as stated. i Cusiomer Signature Date Pa l;-I t vie. Pri ted Name Sli 15 Home Improvements �v Da te Scott Sica Cusfomer Signature Upon Completion. Date i � NORTH Town of over No. asr o dover, Mass., _C0r..C /�� q� o7a0 3 W: "CQ 0 RATED i*' C5 WARD OF HEALTH Food/Kitchen PERMIT T D Septic System S.... ........ BUILDING INSPECTOR THIS CERTIFIES THAT............ .... ... ....... .... .... ..... ... . ... ......... ....P...... .......4.......�#.......z.................. a ...................... Foundation • 4.1 0/0 has permission to erect...Wfeft!Pf'....... buildings on .....SA.2....... go 6C.Oe#10..... ......4............ Rough to be occupied as.....Aq!j"04 IP*r DOV141 a4ve'e'& Chimney ..... ............................................................................................................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes andB -Laws relating to 1he Inspection, Alteration and Construction of Buildings in the Town of North Andover. 71 2.*5W *'j ave PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations. Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ...... ... Service .......... .... BUILDING INSPECTOR . Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ` Date...` ...c... .—n .... NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SswcHusE� This certifies that ....`�'�..'....... Yy. ..... ................................ has permission to perform.,*' � -�� -� ................................................................ - .L�,.-- wiring in the building of..�.......:.....�,,-:-:-5::.......................�....................... at...�` � ..u... ....!�/�..../..� ,North Andover,Mass. Fee:A� .... Lic. Nog:p"� g{/G / ................................................ ELECTRICAL INSPECTOR Check # /yam � 04 TIM COMMONH ALTHOFMASSAC Office Use only HIISETTS _ y DEPAR7A&WOFPUBLICSAFHYP �# ermit No. BOAROOFFIREPREVEMONREGUTA77q S527CV ]2.00 Occupancy&Fees Checked APPUCATTONFOR PERART TO PERFF ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH T MASS- STS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover. To the Inspector of Wires: The undersigned applies,i for a permit to perform the electrical wor es bed pelow. Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service —lam Amps Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work C < 7 T (,,,fid(/( 77 « $t� No.of Lighting Outlets No.of Hot Tubs No.of Transformers t Total V KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground 1 4 No.of Receptacle Outlets D No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW NQ,of Sounding Devices Na':of Self Contained11 Det�ction/Sounding Devices No.o.ocif i Dryers Heating Devices KW Local Municipal Other Nf Water Heaters KW No.of No.of Connections Signs Bailasis No.I. dro Massage Tubs No.of Motors Total HP OTHER- fi1%==Covaaga RouaittottEoWtmimNofMaWhlsettsGeneialLaws [haveaamerltLiab&tyllust mwPbheyiwbdffigComplie CovetageorifssubsullialequivakTA YES NO [havestlbnrittedvalidpwofofsametothe0ffm YES FT ffyouhawdededYES,pkmmdicatttletypeofoD by J)0dd lgthe X. NSU:ANCEa BOND GITIM F-1 (Please Specify) ExpitalimDate Estimated ValueofElec"Wotk$ NolktoStatt kgecdmDaeRWsted Rough Final iigned underlie Penalties of p gjuty. IRMNAN ELiomseNo. .TcMM I a to F L ►N(�Q Rd f WSignatule LiomseNO BusinessTel.No. Al -d P ,mss 71 I/W t l/1 S�— //��e V t N iTel,No. --29-/ :S oo9- /G6/ )WMER'S]NSLRANCEWAAfEP,Iamawatethat the L omsedoes not havefir-insurance coverage critsabs["alegtuvalentastegtmedbyMassachusezCxnetalLaw� e7y d thatmy signatuteon this petrnit applicarion waives this iequaenx nt / �-� 'lease check one) Owner ®• Agent Telephone No. PERMIT FEE$ fgna ure oT Mwner or Agent W The Commonwealth of Massachusetts > Department of Industrial Accidents d � d p dents Office of Investigations Boston; Mass. 02111 Workers'Compensation insurance Affidavit Name - Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer rovidin workers' compensation form employees� ees work'n n providing p Y p Y Igo this job. 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 or MGL 152 can lead to the imposition of criminal penalties af,a fine up to$1,500.00 it and/or one years'impdsonment_as_well_as_civil.•penatties in.the farm jof-a-STOP WORK ORDER.and_a.fine_of-($1.0.0.00.)-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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only • do not write in this area to be completed by city or town official' City or Town Permit/Licensing / Building Dept ❑Check if immediate response is required p Licensing Board r-1 Selectman's Once Contact person: Phone#. Health Department f-i Other • 14 0 R 7*11 4 1 r 0 m o ti. DA COC/NC CW/CM `7` -9 0?A rE c �Pa� 5 SS'gCHUSE� T 0 W N O F N O R T H A N D O V E R DATE: NORTH ANDOVER, MASS PERMIT—# 57S S I G N P E R M I T THIS CERTIFIES THAT has permission toe r ct on cif r provided that the person accepting this Permit shall in every respect conform t6 the terms of the appli- cation on file in this office , and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover . VIOLATION OF JHE Zoning or Sign Regulations , Section #6, Voids this Permit. Inspector of Buildings TOWN OF NORTH ANDOVER SIGN PERMIT APPLICATION Site Owner 1-0 Applicant -e k.,, V-." r o - vS iC,aJ Site Address S2_2 Ccc. � v R-� � Size of Proposed Sign c.p How attached: (a) Against the wall ( ) (b) Roof ( ) Illumination: (a) Not illuminated (XI (c) Ground (' (b) Internally illuminated ( ) (d) Other ( ) (c) Externally illuminated ( ) Proposed Colors: Background WI}i�' Materials: 3/4,, V LL?app Lettering 'T3i_^zc. 4ui5� CkZbew 7 Border czwrq Required Attachments: Note: Photographs of building No permanent/temporary sign shall be erected, or Material sample enlarged until an application on the appropriate form Color samples ✓ furnished by the Sign Officer has been filed with the Site or Plot Plan (Required for all free-standing,- Sign Officer containing such information including signs) photographs, plans and scale drawings, as he may Drawings of proposed sign ✓ require, and a permit for such erection, alteration, Other, specify or enlagement has been issued by him. Such permit shall be issued only if the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By-Law. Will sign overhang any public road or walkway: Yes( No Q� � ` 9 99T If Yes, Name of Agency who will provide liability insurance: JU - iNG l?EP�:RTIihC�iT AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED. Date Filed: - C� Signature of Applicant - - - - - - - - - - - - - - 'v 1 S - / �/ TEL �� �l �s 37 2— 041 E3 R. {P � l TE � II X661 6 C1 6 )7Y-\ 4 xk:�F'l AQ 4 . AM C3 ro luu --IV o } Q Q i ' �fh (JCVVC3NO]HH UO 1 ` vV 3 0 o O iD Lug �w I t %-1, ��� �k�. mos-r-s . • i 2 /// t J I • I I I I I I -- -r AL n I Ipg@ os�p O I y d LV(D nD7U L%HD(oYEfl ' NEDCb%Li CEH7ER µ Be o BEIN13011 $ I 0 D 40 y a � • LEI _ _ 4%G b.�' 'IZA%("TV-P Mitxo - I I . I I 1 I . I I I � I I SEP , .I I ; 19.9� 1 Location 52L (Lk�d kiM/0�� 6,41D No. 6179 Date -7112 N°RTM TOWN OF NORTH ANDOVER- 0 0?0:4,x•0 Z. � N L.arA „ Certificate of Occupancy $ � 41 Building/Frame Permit Fee $ Mus Foundation Permit Fee $ S�c Other Perm"it Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 167 Building Inspector ' Div. Public Works PER-ziIT NO.-c '27S APPLICATCON FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 -EMAP 44►3. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE i ZONE I SUB DIV. LOT NO. I i LOCATION lC, t')!! /y Z /7 PURPOSE OF BUILDING /1 v w` w` pie 1� '_�� OWNER'S NAM 5 H ` lD`_N � v,` l•% //�� NO. OF STORIES ` SIZE OWNER'S ADDRESS T `�/OY1N 'S y" BASEMENT OR SLAB as ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST �1 y t 2ND 3RD BUILDER'S NAME /� l �N S,. ' v ••-- 1 SPAN DISTANCE TO NEAREST BUILDING l DIMENSIONS OF SILLS _- �-� ' 14) , DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES - SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yes IS BUILDING CONNECTED TO TOWN WATER YY +.) BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION L D COST SEE BOTH SIDES BL ��j((�� KIWI v'O EST. BLDG. COST - Z Q PAGE t FILL OUT SECTIONS I - 3 BLDQ PERS I fa— � � EST. BLDG. COST PER 66. FT. PAGE 2 FILL OUT SECTIONS t - 12 •6.a y L EST. BLDG. COST PER ROOM DUE FRMSE RM �� ��7 �� SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING �JL �s +}'+��"+" 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS P ,iANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ✓/ /DATE FILED (r " T / BOARD OF HEALTH YY SIGNATVAE OF OWNER OR AUTHORIZED AGENT FEE 7 PERMIT GRANTED OWNER TEL.# PLANNING BOARD �u 9 CONTR.TEL. # 11,70-04v 4"C t s _ CONTR. LIC.#0000 S.3 BOARD OF SELECTMEN 157 JUN 3 01994 -7y�sr- - BUILDINO INS• \ ' TAC)RTH own of 6 Andover _J& No. 278 IV �o �y ort- T 15q� � A05'ATED�S IL BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �ott� L BUILDING INSPECTOR THISCERTIFIES THAT......................... ��................................ ..A...................................................................................... Foundation has permission to m%4..... ........... buildings on ..SZz-...C.l 4 k3MW.0. ..*'....Cw.+,o........... Rough p' 1.� 1 © " Chimney to be occupied as............................. ........... 4.�. .........r f.t"u. ........................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of . Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough { Final ` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ` UNLESS CONSTRUCTIO TARTS Rough 1' .................................................. ��,............................. Service BUILDING INSPECTOR y Final t` Occupancy Permit Required to Occupy Building GAS INSPECTOR -- Display -in a Conspicuous -Place on the Premises — Do Not Remove F nalh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. i SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT 7 � g _ n + k ' y `����''����Zj'� 1( �,�i•,�R3n?,ik`��� ,y ifd�s►�Ynii5`'(S; r�}.� - --.+ �'� ,4 '• 1 �, i ,}> a...'4�rr�i>y"'•C• y I��f�,�l•t I, r1+$� ft, 11111Z•`T`171� :�' , •; +..:1 ; '',' . J 14r e. � ,� '�, }5+. )� i � 1 \r �y ,..1\ +.11'1 S ��ts � _ 1'• t }, ♦ S1\1 ( o i 7t, . t \r1 it, r I i•l.: 7 9 ;•li t< i i ', +.t I ) COMMO DEPARTMENT OF P OF PUBLIC$AFETY ' ` ': MASSA1rHUS ONEASHBORTON PLACE BOSyOA*MA 02108 EXPIRATION DATE � �'1 CONSTR�I�SENSE� ' \ # 09/12/i995UPERVISOR ' RESTRICTIONS ICTIONs EFFECTIVE DATE r.l, .�' 'r , l! 1 •+ I 1' E LIC-NO. 06/30/1993 000083 { SS 8 025-32-9419 10OFLEMINNER ANDOVER MA 01810 •y PHOTO(BLASTING OPR ONLY) 00 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY ' HEIGHT: I STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: 9/12/1943 • - THIS DOCUMENT MUST BECARRIE ��4 N PERSONOF THE + THE HOLDER WHEN EN- GNATURE OF LICENSEE OTHERS-RIGHT THUMB PRINT GAGEDINTHIS " ' OCCUPATION. ' ,SSIONER ' r,•,-T•.,-,... Sin T-��� .--„a• _ ej, tN. � ' ) d G f. 1 _T1. amt7novwJv¢ll�o�/�aaoac�uaella i r,a ' ;• HOME MP�OVEME i CO'I i 4C i OS RegiStration 101041 Type Ts _ Expiration 01/28/'i4 Pohle- Co1StT UCtion Co. Leo E. Poirier 10 Fleming AVenUe ADMINISTRATOR Andover MA 01810 • j• t � it y'.f% 11 '.r"'� n •� •! r 1. . . . :f •, r _ r' r rr..? r f�:id fir'✓" ,) rs J�J.1 t -} .r - ,a •� r -.r l's/�e,f �r t.r i/_t�/ •1 it r 3 a > i i • - :}(sem M /•'1" araV nr/ rr•' )f', ; r. r />• '��,•'�?�v,�'r•?rferal..!rrJ'i�rs�?s+,,,r, v . h ^r FF P"W POIRIER OONEF yi�a I " i1r►dowr, w ���t� ��- G >> 1 P O SAL SUBMITTED TO PHONE DATE STREET JOB NAVE } '. CJTY,STATE and ZIP 90DE A- JOB LOCATION ARCHITECT - DATE OF PLANS 1 / JOB PHONE We hereby submit estimates for: 4121 A/ Ap- V We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars $/ + Payment to be made as follows: .''•�� tri---� �'��s J ��.�A��sc�- � .� - d r - All material is guaranteed to be as specMed.All work to be completed In a i workmanlike manner according to standard practices. Any alteration or Authorized ' deviation from above specifications involving extra costs will be executed Signator@ �✓F'—r ` �' `may" `"' only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. NOTE This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Acceptance Of � . — The above prices, specifics ions and conditions are satisfactory and are hereby T ' accepted.You are authorized to do the work as specified. Payment Signature will be made as outlined above. Date of Acceptance: signature- r� '.-".'"`."_'.---.L'":_"'„f- .. � _ . '.l. - ." yr � .._- .r _. ..�..✓. .. -.. . - .. ,. a ., �.`.�y —w•........� �.. k' il, f �r ",� r tIF Ail Tr v n .4 �„ ru �y 40 ,. x 1 zv z X � z = WW .t VI — LJJ = —En x + O W •J • ./ Ah a RE STA ATIO ' -' EASY SLIDE'"' Ji N S 1 R � � 11 1 1 ji� CR , t'-' . f / SOREd EX MEDICAL SYSTEMS 201)Beach Airport Road Rt.21, Box 200 { Conroe,Texas 77301 ( 109)760-3198 r I ' F 6„ CEILING I co (D j i F� 5 I. IO [` co c . I } OUTLET TYPE: NEMA 6-15 220 VOLT-- 15 AMP SERVICE FLOOR LINE Fig. 1.1 Side View I 2 x 4 (or larger) with ' 2 Bolts @ Each of 3 Wood Studs - Finish 2 x 12 00 i I'I I I I • I ' I I Column of PAN I and/or CEPH �= 1 I I I I Finished Wall On 2 x 4 Wood Studs S- 86" j . BRACKET HOLES ARE 16" CENTERED AND CAN BE MOUNTED TO WOOD STUDS W/O FACIA BOARD; SPACE 0000000000�'00 PERMITTING. X-RAY BACKING on finished wall (if studs are not conveniently placed) 4 SOREd EX APORTANT: CONSTRUCTION DRAWING SHOWS TYPICAL , Medical Systems UST COMPLY WITH LOCAL CONSTRUCTION OF WALL 200 BEACH AIRPORT ROAD UILDING CODES! BACKING TO SUPPORT RT.21,BOX 200 SOREDEX CRANEX PAN AND CONROE,TEXAS 77301 (800)235-8854 CRANEX PAN/CEPH X-RAYS. FAX(409)760-3184 i 2x10s to ceiling post �I Column of PAN and/or CEPH C I I ' 1 J 2 x 10 - Flush w/stud - to Support 500 lbs. Pull Extra 2 x 10 at Top and 86" Bottom Suggested Metal, Studs X-RAY BACKING on metal studs �I SOREd Ex Medical Systems IMPORTANT: CONSTRUCTION DRAWING SHOWS TYPICAL 200 Medical AIRPORT ROAD MUST COMPLY WITH LOCAL CONSTRUCTION OF WALL RT.21,BOX 200 BUILDING CODES! BACKING TO SUPPORT CONROE,TEXAS 77301 SOREDEX CRANEX PAN AND (800)235-8854 CRANEX PAN/CEPH X-RAYS. FAX(409)760-3184 Column 'for PAN 2 x 10 Flush w/Stud - and/or CEPH To Support 500 lbs. Pull t • Extra 2 x 10 Top and Bottom Suggested 00, 100 � ' II i i I II G I � II 86" X-RAY BACKING using 2x4 wood studs �1 SOREd EX IMPORTANT- CONSTRUCTION DRAWING SHOWS TYPICAL Medical systems MUST COMPLY WITH LOCAL CONSTRUCTION OF WALL 200 BEACH AIRPORT ROAD BUILDING CODES!, BACKING TO SUPPORT RT 21,BOX 200 SOREDEX CRANEX PAN AND CONROE,TEXAS 77301 (800)235-8854 CRANEX PAN/CEPH X-RAYS. FAX(409)760-3184 Column of PAN - and/or CEPH y 1 /2 Toggle Bolts Qr 16" O.C. Vertical ` �� 2 - 2x 10's - Full Height of Wall - , O Backing to Support O 500 lbs. Pull O O r, O O O O O 86" Concrete-Block Wall Behind X-RAY BACKING on block walls �4 SOREd EX IMPORTANT- CONSTRUCTION DRAWING SHOWS TYPICAL Medical Systems MUST COMPLY WITH LOCAL - CONSTRUCTION OF WALL 200 BEACH AIRPORT ROAD BUILDING CODES! BACKING TO SUPPORT RT.21,BOX 200 SOREDEX CRANEX PAN AND CONROE,TEXAS 77301 (800)235-8854 CRANEX PAN/CEPH X-RAYS. FAX(409)760-3184 tl, ,m i 13" MINIMUM TO WALL FOR CLEARANCE ONLY 30" �♦"13'_-► .-16"—► X13'1 RECOMMENDED MINIMUM ,eeCEILING FOR EASE OF POSITIONING .o o: B� 4 °' LEFT o B WALL :.a a 90., TZ o: MINIMUM 00 FROM FLOOR 'o. o. TO CEILING 'p �p 4 SINGLE RIGHT PHASE WALL d SERVICE :a .a 10 FEET OF CORD PROVIDED FLOOR LINE Fig. 1.2 Frontal View 4 TECh N iCA[ DATA High frequency generator, operating GENERATOR g q �'DC g ' frequency 40 kHz X-RAY TUBE DE 100/150 FOCAL SPOT SIZE 0.5mm x 0.5mm, IEC 336 MIN. TOTAL FILTRATION 2.5mm Al ANODE VOLTAGE 63-81 kV ANODE CURRENT 6 mA and 10 mA (4.5 mA and 7.5 mA in I compensation mode) EXPOSURE TIME 16s (60 Hz) CASSETTE 15cm x 30cm (6"x12") panoramic SID 520mm RATED NOMINAL LINE VOLTAGE 220/240 VAC±10%, 50/60 Hz OPERATING RANGE 175-270 VAC FUSING 8AT slow WEIGHT 150 kg (331 lbs.) COLOUR GAT 11152 ELECTRICAL SAFETY ACCORDING TO IEC 601-1 CLASS 1B (UL Listed) i Specifications subject to change without notice. � 47 , 00 1691 1 Fig. 1.3 The Suggested Floor Space for _j�:rgnex__ _. AGENERAL -INFORMATION Minimum Space Requirements Height of Room Minimum 90 inchest + Width of Operating Area Minimum 40 inch-- r Depth of Operating Area 5 al �/Ilk If width dimensions are smaller than recommended, operator will have difficulties in positioning the patient. Please refer to the enclosed diagrams for more information. Electrical Supply Data for the Cranex Pan/Pan Ceph Power supply The CRANEX operates on a voltage range from 175 to 270 volt. To assure proper line quality, a separate three-wire grounded circuit connected directly to the distribution panel and an over current pro- tection rated for 20 amp breaker slow, must be used. On request the focal Electrical Utility Company will perform a voltage regulation test to verify the line quality. The CRANEX requires a line I voltage regulation not exceeding 3 percent. How to select the proper wire size The line voltage drop in the power supply circuit from the central dis- tribution panel to the CRANEX X-ray unit depends on length and size of wire. The'distance from the distribution panel to the CRANEX control box must be measured, and the minimum size of copper wire selected with the,aid of below chart. CHART FOR NOMINAL 220 VOLT POWER SUPPLY MINIMUM ' WIRE SIZE DISTANCE IN FEET 25 50 75 100 125 NO. 12 AWG NO. 10 AWG NO. 8 AWG N Power cord receptacle The CRANEX power cord with plug cap is a three-wire grounding type and must be connected to a properly gounded, UL approved, a` three-wire receptacle. (NEMA 6-15) JUL E ' V