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of NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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has permission to perform .... �' �� �t is 6 ,v\ ks
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wiring in the building of......�,/L� V�- " �'` � c-
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Fee..., * ........Lic.No. ..'1 .....................rll /..�r z/�/��• /�(_
ELE RICAL INSPECTOR
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elJeParEmsnE o��ira Jewice� Permit No. 17,1 U 0
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. ilq leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINTDVINKOR=EALL INFORMATIOM Date: 12/1/14
City or Town of: North Andover To the Inspector of Wires:
By this application the undersigned}rives notice of his or her intention to Derform the electrical work described below.
Location(Street&Number) 54 PeteR St
Owner or Tenant Dipak Bhaqat Telephone No. 978-683-2216
Owner's Address
Is this permit in conjunction with a building hermit? Vic ❑ No 0 (Check Appropriate Box)
Purpose of Building Commercial 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 Ampa¢ity
Location and Nature of Proposed Electrical Work: Installation of temperature and fan controls on walk ins.
Completion of the ollmvin table may be waived by the Inspector o [Fires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of ata!
Transformers' KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ a.o mergency ig ng
rnd, rnd. Bntte Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection an
TotaInitiatin Devices
No.of Ranges No.of Air Cond. Tons! No.of Alerting Devices
No.of Waste Disposers Heat Pump Num er ons KW No.of elf-Contain
Totals: Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Devices or Equivalent
No.of Water KW No.of• F0—.o f Data Wiring:
Heaters Signs Ballasts 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 Hfires.
Estimated Value of Electrical Work: $2000 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with IvIEC 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 x BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perJnry,that the information on this application Is trite and complete.
FIRM NAME: Nallanal Resource Management,Inc. LIC.NO.:17314-A
Licensee: RogerA-ManteJr. Signature LIC.NO.: 17314-A
(If applicable,enter"erempt"in the license number line.) Bus.Tel.No.--7131-528-8877 ext las
Address: 450 Neaonset SL,Blda 2.Canton.MA 021121 Alt.Tel.No.:
*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
Signature Telephone No. PERMIT FEE:S 125
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t t, ti DeP rf/3mepf of lilt ll.t al Accidents t � Merits _
Office oflm=estigatiolls
600.Wushitt9101r Street
" Bosttrrt,MA 02111
x tvluw nrrtss g(ivViilin
Workersi,",'Compensat o'n Insurance-`Ai(fid vii: Bui'Idets/Contractors%Electric ans/Plumbers:.
AnWicant Information Please Print Le2i61v
Nattle(Business/O(gapirationllndntdual) >,NATIONAL RESOURCEMANAGEMENT,'INC.
Address: 480 NEPONSET STREET,BUILDING#2
city/StateiZ CANTON ;,e'er o✓1M e Phone# ``•;781-$28-8877'X132 ,
' ,A're you,an ernployer?.Check'the appropriate box:
Type of project(required)
1.Q am a.cmplolcr v�ith 754••❑ I ata a general c�intr ietor:and I , -
� + have hired the sub vont,406'es [New construction'
cmployce's'(full and/or part=time„
.❑ f am a�sole propiieiat or patine r= listed on the attached sheet 'i"❑Remodeling
These sub-contractors or5 aveshi and have no em loycs 8
❑ Demolition
i 5t'orl.rnu doe me iii an capacity;., employees and hove>varkers' 0. 0 Building additidn.
Ig [No workers<coni, insurance corny.it stirance.+
�5. 1��c area ca oration'andits'� 10.�'Electrical repairs or additians
required.], ❑�, rp
{` 3.❑ I am a homeovvnerdoing all w=ork officers have exercised their, E'lumtin=:repairs or additions'. `
,}self. IT_o workers'comp: ` right of exemption per MGI, 12.Q Raot'repairs
insuriince�requdedj t, ,;c 152,§1(4),and we have no
" employees.(Na�4arl.ers' 1'I D Other,
,f
a
.. ... .. .. .n. `� t omp,insurance required.];.
r v,ripp�icant that chce! boy M I must also fill oul the s�etion,below sho(}nt their vtiirrhers compensation paley`itifotm siiori.
t omen Hers whosubmit this allidavii indicating clic are doing ail woil and then line mu de'cil" tors must submit a neW affidavit indicating sueh`.,,;
Contractors that check this`6aN rnuat attached an additional sheet shorn ing the nano of the subatintraetors and state whether or not those entities have
imployees. ifthesut'l-, hecto haveetitptoyces,t}iC}mustprilvidetheir tiorkerc"cQmn polio}number.
:
/ant art entpla}er that rs prndidin s worker s compensation hisitrartc� ar rn -vin la ees Belnii°is the ahc and'ab site
f _ Y, .p_ }' P } l
tnjormat1an
;Insurance,Campi0y Name; 'GUARD 1NSt1RANGE''COMPANY i
Pohc} I°ar Self ins Lie #- NAWC42541
. , ... .. ,. 0, o30115
� n"Date. 09t _
i° ;glob SrtCalddress City/Statc/tin. Y
Attach a copy of the^wdrkeis'.cotttpematton pokey-A,ec aration page(shovong the"'pohcj n'umbcr and expiration date):
t' ]'allure to.securecoverage as r`egtiired under Scctfon 25x1 oh MGI,c,352 c.arf cad to the imposition ofc riiuinal'penalties.ol a
`Eine iip Aii 51,500;00 and/or one-year imprisonment,<as well as civil penalties fti the foriit of a STOP WORK ORDER and"a fine
of 004.0 5250.00 a dav`agautst tfiefv tolator '.Be advised that a copy ol'this,stateifficnt may he forwardt:dIb the•011icc of`
htvesti•g
aeons 6f'th6.D111lor insurance e:overage;�v=erificatiin.
.140 hereb I cern f•urtrler the aarris and enalties o,-perjur} shat the nfarmafrau prtwirlerl al ct►e is trrie n�rtl ci7rreet.
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Stenaturc:
Date:. .
Phone th
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Official use ono r
•. Da tot write°in this tires to h
.rf .► ,, e conrpteterl h}•;rift' 'or tp►vn affieltrl., .
City or Town: Permit/License#±
Issuing Authority'(:circle one):
a' 1.Board of Health"2.,Building Department;3.Cityffown Clerk 4.Electrical Inspector,5.Plumbing Inspector`°
t G'Other.
B` 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"eve
rystate or local licensing agency shall withhold
the issuance or
renewal of a license or permit to operate a business or to construct buildings to the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required:'
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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 f
Po cY 9 o Industrial
Y eP
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 permittlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel.#617-7274900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
www.mass.gov/dia
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Client#:36673 NATIORES
ACORD. CERTIFICATE OF LIABILITY INSURANCE
1010312014THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOLS NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCMS
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHOR12ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:H the cerfllkaEo holder Is an ADDITIONAL INSURED,the policy(fes)must be andomed.If SUBROGATION is WAIVED,subject to
the terms and cond0lons of the po0ey,cerWn pog des may require an endorsement.A statemant on this oertiflcate does not confer deft to the
eertifh:ete holder In Ileu of such ondoreemert(si.
reODUOM Brenda Hovey
StarkWeather S Shepley 781320A660 N, 781801
11SU ACO Corp.of MA
PO Box 648 Obt
Providence,RI 028014648 a�oRoelocoveRaoE 111AIe6
MURGRA:CNA Insurance 03872
=uRm a..Endurance American Specialty 41718
National Resource Management,Inc. atillRetc;Guard Insurance Group
480 Neponset Street,Bldg 02
Canton,OAA 02021 atsttrmeo:
IN6uREREs
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTYMMANDMIG ANY RECiUREMENT,TERM OR CONomoNOF ANY CONTRACTOR OTHER DOCUME Nr WITH RESPECT TO V%QCH TM
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DWORtBED HEREIN E SUBJECT TO ALL THE TERMS,
EXCIMONS AND CONDITIONS OF SUCH POLICEE:& LIMITS SWM MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPEOFDEIINANCH POLICYNUNBER ANA ANA Uwe
A oENEtALIAmmay 5 1=112014101011201 EACHoommRENce :1000 000
0011ifM aALWOULUASIUTY mm=nw 1300 000
C AIMSHADQ COCUR MEDE)P oe Ban $6000
PER90NAL8ADVDIJIJRY i1 060
oENEMAQMUMTE $ 000 000
Mn.AtrsReaATEUMTAPPUESPM PRODUCTa•001IMPAW 6 000000
POLKY Mx29IDCI Ii
A AuT0110su u u mm 6096093603 01011=14101011201 1 000
A X ANYAuro SCKEDULED 6086162646 1010112014,1010112011 B=Yatmawliar aro 6
A amw X 8=YMA RYWa tA" 6
lamw X HUtEDAUT08 X A{R 6
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B X saeRELLA UAB X Ooaat EXCI0004266300 1010112014 1010112014 EACH occ RENCE S-500-0000
E XCESS LI AB CLAMtS4AADE AOOREQATE 66 000 000
ow I X1 wrMMS10000 I =
C AND��E VIN NAWC426410 0/0112014 10/011201 X '''i°61 M
N N'A E-LEAXHA 61000000
ELDINME-EAEMPLOIS $1,000,000
E.LaSEASE.Fft=UeT 61000000
DUMPT=oP oPE WIM I LOCATIONS r VSISCLOµ►rte:ACORD rot,AWMand R=aft Sdw*,Ie,If ease apsos te:o�aoa►
CERTIFICATE HOLDER CANCELLATION
For Permit Use Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRAMON DATE THEItEOP, NOTICE WILL BE DERIVE M IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORED REPRESENTATIVE
®1686-2010 ACORD CORPORATION.An rIghts reserved.
ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
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CERTIFICATE OF USE & OCCUPANCY
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TOWN OF NORTH ANDOVER
Building Permit Number Date d dd
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS � a ` (C jo
et IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
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CERTIFICATE ISSUED TO S�oc-K C O IN
ADDRESS
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Food/KitchenrE" R M IT T D Al/Septic System
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THIS CERTIFIES THAT......... ...... �� .. ..... ..I �' S
Foundation
8 has permission to erect.... N . .... buildings on � .... :..................� /.................... ................. Rough /di• .
to be occupied as..... ' !'®.. .....Fd! ..../ ...,....1// .� . . �/ ...., f•®.. ............................ Chimney
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provided that the person accepting this permit shall in every respect confarm 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 Insp ction, Alteration and Construction of " "`�`
Buildings in the Town of North Andover. /4 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. RoughArloo
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PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTO
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. .......................♦.... ........................................... Service
BUILDING INSPECTOR A;1d;
Occupancy Pe11nit Required t0 Occupy Building GAS INSP CTOR
Rough
_Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
4
Until Inspected and Approved by the Building Inspector. Burner
\ Street No.
SEE REVERSE SIDE smoke Det.
TOWN OF NORTH ANDOVER
OFFICE OF
COM1VtUNITY DEVELOPMENT . SERVICES
27 CHARLES STREET
NORTH ANDOVER,MASSACHUSETTS 01845
aoRra
ot,t,a '.. Telephone(978)688-9545
,y'.v °A FAX(978)688-9542
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TO: Janet Eaton
Assistant Town Clerk
FROM: Michael McGuire
Local Building Inspector
DATE: September 28,2000
RE: Denrock Liquors
58 Peters St
Please be advised that as ofthis date Mr.Burliss has n1
s o y submitted equipment&
shelving layout and site plan.He has been made aware of other approvals required from various
other departments and has obtained the appropriate blank forms.
Please be advised that upon research of the site the following observations have should be
noted.
1) The plaza has been in existence for over 20+years with the approval for the associated
uses.and parking at the time it was constructed.
2) The number of retail and food establishments does not appear to have changed in 5+/-
years.Rocky's Ace Hardware,Hit or Miss,Val's Diner, Supercuts,Mastercraft Cleaners,
A Bank ATM and Burgerking.
3) Of these establishments only the Val's Diner and Hit or Miss are changing into Panera
Bread and Denrock Liquors which are identical uses
4) With an expansion of 1178+/-Sq.into the proposed Denrock liquor for Panera bread is
the kitchen area and the number of seats compared to what Val's had is being reduced.
5) The above therefore reducing the retail floor area of the liquor store.
In conclusion it appears that the addition of Denrock Liquors is not a significant change that
would affect the site or surrounding area in a detrimental way.
i
:1
4
Square Spaces Spaces Req Number Spaces Spaces Required
Establishment Feet per Sq. ft. for Sq.Ft. . of Seats per Seat for seats
Panera Bread 4355. 15 65.3 100 2 50.0-
Burger King 4226 15 63.4 112 2 56.0 `
All other retail 22504 5 112.5
Subtotal-Spaces Req. 241.2
n Spaces Provided 167 4
Retail Squre Febt Parking 112.5
Seats and Squaret Feet 218.5
Spaces Provided 167.0
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