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Miscellaneous - 60 WILLOW STREET 4/30/2018
Location �'= ---� Na, Z Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ cMust`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL y Check # �l rip 151 % b Building Inspector/ v TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING vim' #"' 5'i i:�`' 4'. .W 5' xr {y�df5.�k 2&�",y Section for Official Use Onl k5�^h:. > _ �,��. ��.� ��,� . � ,�� � BUILDING PERMIT NUMBER: DATE ISSUED: � 1 .. l ,�j� G calc-� SIGNATURE: /U Buildin ommissioner/laTedor of Buildings Date SCT' r,...,s 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 60 Willow Street 98D Lot 18 Map Number Panel Number North Andover, MA 1.3 Zoning htformation: 1.4 Property Dimensions: I-1 Industrial 1 80,000 150 Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Regaired Provided 50 150 50 5 T- 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record Rohm -Haas SAM25 Fetiov\ 60 Willow Street, North Andover, MA Name (P ' t) Address for Service: 978-557-1707 Signator Telephone 2.2 Authorized Agent Dutton & Gar ield, Inc./Stephen E. Foster, 54 Beechwood Dr., N. Andover Name PrintAddress for Service: ZA���� 978-681-8600 Signature Telephone ;y Y 3.1 Licensed Construction Supervisor Not Applicable ❑ Stephen E. Foster 029376 Address License Number 48 Meadow ane, North Andover, MA 01845 02/28/02 Licensed Con sor- 978-681-8600 Expiration Date 8 Signal j4 Telephone 3.2 IZegistered Home Improvement Contractor Not Applicable XI N/A Company Name Registration Number Address Expiration Date Signature Telephone 'a M Z v M i 0 M X D Z O Z M 90 O r Cv M r r YI I, Stephen E. Foster as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Stephen E. Foster Print Name 11651A -A � November 26 2001 Signature of //Ajelft Date i'it7►7�i'. Item Estimated Cost (Dollars) to be i;1(7S+lj Completed by permit applicant 1. Building (a) Building Permit Fee $20,000 Multi lier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) I (� 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number $20,000 F'..� .C� Y ( (rP✓d . f{kt ""04 s 'Si' NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr2 ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING Reference attached Structural plan S1 dated 10/3/01 by MATERIAL OF CHIMNEY Quinn Brothers, Inc. IS BUILDING ON SOLID OR FILLED LAND Solid IS BUILDING CONNECTED TO NATURAL GAS LINE Y ti V a- �e c"uw u =s•": SECTIONa YORK ItlS cr © +� JIM .. Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea ......M No ....... ❑ SECTION 5 - PROI F-WOXAL )U1[Gx`- LtS 10`OR;::01�LDtil i3R 5 SU t"i T CONSTRUCTION CQ1 TR47L ��O786 35,U4U "V ENC%OS11 SflACJ�) 5.1 Registered Architect: ; N/A Name: Address Signature Telephone .5.2 Registered Professxet�� l�ngi�s)* , - Structural Construction Engineering Services, John S O'Connell Area of Responsibility Name: 28967 12 Pleasant Street, Newburyport, MA 01935 Registration Number , -?o -off Address: 978-465-2216 Expiration Date Signature Total Not applicable ❑ 'Name: Registration Number , Expiration Date F Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number 1 Expiration Date Name Address Signature Telephone `+ Dutton & Garfield, Inc. Not Applicable ❑ Company Name: Stephen E. Foster and/or Keith A. Wentworth Responsible in Charge of Construction a NOPT1,.. ,r" Optp> �0. €r�k all.appl�cable�' New Construction ❑ Existing Building ❑ Repair(s) ❑ USE GROUP Check as applicable) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other X Specify Utility Building (E t, roof canopy) Brief Description of Proposed Work: Steel framed roof canopy and associated steel reinforced, poured concrete footings for weather protection. 30111 B Business ❑ 2A 2B 2C Structural Engineering Structural Peer Review Yes ❑ No E SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Herebyauthorize Dutton & Garfield, Inc. /Stephen E. Foster to act on My behalf, in all matters relative two work authorized by this building permit application A f%A k A 46-67� 11- 'a1 -OI Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 0 A-3 ❑ ❑ IA IB ❑ ❑ B Business ❑ 2A 2B 2C ❑ 0 ❑ C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 0 1-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ Uutility X Specify: "Weather Canopy" for equipment protection M Mixed Use ❑ Specify: S Special Use ❑ Specify: C43MPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: N /A Existing Hazard Index 780 CMR 34: Proposed Use Group: N /A Proposed Hazard Index 780 CMR 34: Structural Engineering Structural Peer Review Yes ❑ No E SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Herebyauthorize Dutton & Garfield, Inc. /Stephen E. Foster to act on My behalf, in all matters relative two work authorized by this building permit application A f%A k A 46-67� 11- 'a1 -OI Signature of Owner Date 1, Stephen E. Foster as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Stephen E. Foster Print Name November 26, 2001 Signature 0fAl /'�Ajefftyj.y Date . . .... ...... I Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building (a) Building Permit Fee $20,000 Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (h)30 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number $20,000 K. M M V, '!'g NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS i ST 2 ND 3RD SPAN DEMENSIONS OF SELLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING Reference attached Structural plan S1 dated 10/3/01 by MATERIAL OF CBDANEY Quinn Brothers, Inc. IS BUILDING ON SOLID OR FILLED LAND Solid IS BUILDING CONNECTED TO NATURAL GAS LINE V TOWN OF NORTH ANDOVER BUH DING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING x }.: s '2- < ,Etu.. f•w,...-. ,,,,•, ,�..x ,:�- 3,'�i',.:f,This Section for Official Use OnlEW".' BUILDING PERMIT NUMBER: / � DATE ISSUED: V 1 L SIGNATURE: ZP/U Building Commissioner/ or of Buildings Date Y5 T:Aw e' sy �•`� 1.2 Assessors Map and Parcel Number: 1.1 Property Address: 60 Willow Street 98D Lot 18 Map Number Parcel Number North Andover, MA 1.3 Zoning Information: 1.4 Property Dimensions: I-1 Industrial 1 80,000 150 Zonin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide R 'red Provided ReqWred Provided 50 150 50 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zane ❑ Municipal On Site Disposal System ❑ ,-0 r,a. ,4.rt+r::o .t �,;,'+J 'lFrcr' j.•�.; +� s {ff tn' > .. 2.1 Owner of Record Rohm—Haas -50-men N e Rov1 60 Willow Street, North Andover, MA Name (P' t) Address for Service: 978-557-1707 Signatur Telephone 2.2 Authorized Agent Dutton & Gar field, Inc./Stephen E. Foster, 54 Beechwood Dr., N. Andover Name Print— Address for Service: ZA���978-681-8600 Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Stephen E. Foster 029376 Address License Number 48 Meadow ane, North Andover, MA 01845 Licensed Con Sor• 02/28/02 978-681-8600 Expiration Date i Signa Telephone `3.2 Registered Home Improvement Contractor Not Applicable X N/A Company Name', Registration Number Address Expiration Date Signature Telephone 'a M Z v M 11-1 1 0 TM N Z 0 Z M 90 0 ic r v M r r Q 11/09/1996 05:21 5084633522 CES ' t G "grill r KIJt-i W I I Ulv/ VMfSr 1=LV : ' , obiS I / 5 / Lt ap0imum- Nom: bWoahtte Tse PAGE 02 �-.`, ro p►ov'do thiv * i4dvit wil 19=11 in the dcni*l of the CQnStruc ura r n vic sh i S. 0"onne.1i AC`. Nay= � � n M of Rftpon$jbjhty i iz 1 28967.._ Aftem ewbur t MA U 19 35 D—.1k % ORM- 978-465_2216 49—A•—nD.te 2.� low . _ Na efg+l "tdc Addrus�. �__ Rc�►suatior iiwnlxr sipiatuce rekMsoo --� ------ apilation mu- a �— %, Su$ rs Teh iww — _ _ _. Nxtac — Dutton 6_Garfieldi Inc. campmy Now, St IPM 2- lastar an$/er Kaith„&Wentworth Am 'Respantubiury Rte, Mab -.m Nwubrr !`alpha. ion NIC — Ata* *l' R, ;puratbil.. ReQtStteii"N4mba --- Expiration fate -- N, , A*3 able C i%iris (aricrrco�nureall� c�`, l�x�duc�rr;,elli BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR i Number: CS 029376 Birthdate: 02/28/1953 Expires: 02/28/2002 Tr. no: 15184 Restricted To: 00 STEPHEN E FOSTER 48 MEADOW LN N ANDOVER, MA 01845 Administrator The Commonwealth of iMlassachusetts _ - Department of Industrial Accidents ofL reWgmJ1OS -j 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Failure to secure coverage as required under Section :SA of NIGL IM can lead to the imposition of criminal penalties of a fine up to 51300.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1416 hereby certify under the pains and penalties of pei7ury that the infornsa ion provided above is true and correct November 26, 2001 Printnarne Jane I. Armstrong ." Phone;;! 978-681-8600 official use only do not write in this area to be completed by city or tower official city or town: permit/license 9 nBuilding Department []Licensing Board 0 check if immediate response is required osdectmen's Office 0Heslth Department contact person: phone if; 00tber (—i"d 3M PJA) lk Dutton a Garfield, Inc. N CONTRACTORS DATE: July 13, 2001 TO: TOWN OF NORTH ANDOVER Building Department 27 Charles Street North Andover, MA 01845 ATTN: Mr. Mike Maguire RE: Rohm & Haas, 60 Willow Street WE ARE SENDING YOU -x- The Enclosed _ Under separate cover 2 10/21/97 1 of 1 MHF Site Plan • 2 10/03/01 S1 Quinn Brothers Structural Plan/Equipment Canopy ` 1 11/26/01 Town of North Andover Permit Application 1 11/26/01 Worker's Comp Insurance Affidavit THESE ARE TRANSMITTED as checked below: _ For Review/Approval x For Your Use _ For Review/Comment _ For Your Information _ For Bids Due _ For Completion REMARKS: Please call if you have any questions. SIGNED: tephen F. Foster BUTLER 54 Beechwood Drive - North Andover, MA 01845 BUILDER Tel.: (978) 681-8600 Fax: (978) 681-7570 www.duttongarfield.com As Requested _ For Quote For Execution 109 Hillside Avenue • Londonderry, NH 03053 Tel.: (603) 425-2600 Fax: (603) 434-9568 ON rA s? UJ z ch Cd a w° C2 U is w a 0 U a�' co w P0 w � W °�D c� is w °�° w°' m w w x W cin ' Q o cn UJ z WE co cm i 1 O ■O 'E m m co CL CD O Oca i CL CMQ cac vCL ca C co v h c C ■ C cc y 0 CO CD w W W CO C C CD c O o � NOc d VV -AA C. O Rc O m E Q co • C ", V co 0 d N L 7:EsOp o m y o 9 'mc\E O 7m3 (� cmGAGN V C m N O O m 2�ym� f !Z = O Of Nj O V •N O m V: A M. d m e •c = m CL 0 N ~ V� a0+ y O ~ m NJ O m cv =LD � � A = Co E d2 c',2� �_•N Z O U C J CJ � a O _ as m o ca O =0a�m� WE co cm i 1 O ■O 'E m m co CL CD O Oca i CL CMQ cac vCL ca C co v h c C ■ C cc y 0 CO CD w W W CO E � J �a 00 Q. gap two 2 �x Z r Lp CSS E � J �a 00 Q. gap two 2 DECTAM CORPORATION Specialty Contractors January 10, 2011 North Andover Board of Health 1600 Osgood Street Bldg 20, Suite 2-36 North Andover -M -A 'AN 14 2411 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: Rohm & Haas, 60 Willow Street, North Andover, MA 01845 (Lab #1 Organics R&D) 978.470.2860 fax 978.470.1017 Please be advised that Dec -Tam Corporation will be performing an asbestos abatement projects at the above referenced locations. This work has been scheduled for January 24, 2011 thru January 24, 2011. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Brenton Morgenstern Sales Estimator BM/cam Enclosure Environmental Remediation Services • Surface Preparation • Facilities Services 50 Concord Street • North Reading, MA 01864 9 www.dectam.com • solutions@dectam.com f�; L1. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts Asbestos Notification Form ANF -001 ;10011920_7 Decal Number 7rri Jk;.N 141011 UVVN UF IN A. Asbestos Abatement Description HEALTH 1. a. Is this facility fee exempt - city, town, district; municipal housing authority, owner• residence of four units or less? ❑ Yes Fv� No b. Provide blanket decal number if applicable: Blanket Decal Number _ 2. Facility Location: ROHM & HAAS a. Name of Facility NORTH ANDOVER 'MA c. City/Town - - S to s 3 Worksite Location 60 WILLOW STREET b. Street Address _ 01845 _-� ,9786891507 - e. Zip Code f. Telephone Number ANDOVER INSTRUCTIONS LAB#1 ORGANICS RSD 1. All sections of this f _ z _ L.Wi form must be a. Building Name/Building Location b. Building # C. ng d. Floor e. Room completed in order to comply with 4. Is the facility occupied? vi Yes I ] No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: ■ and the Division of Occupational r--- _ —- _ _- - ... ..� I DEC-TAM CORPORATION ._ _ . . i50 CONCORD STREET Safety (DOS) a. Name b. Address notification fr_ READING 01864 ._ 9784702860 requirements of 453 'NORTH _ _ CMR 6.12 c. City/Town d. Zip Code e. Telephone Number AC000035 f'DOS License Number - – g• Contract Type: i Written l Verbal !BRENT MORGENSTERN SALES` h.Facili Contact Person i. Contact Person's Title { GEORGE A. PAGE FAS071933 6. _ a. Name of On -Site Supervisor/Foreman b. Supervisor/Foreman DOS Certification Number - 7. a. Name of Proiect Monitor b. Proiect Monitor DOS DOS Certification Number LI RS _ 000175 a. Name of Asbestos Analytical Lab b. Asbestos Analytical Lab DOS Certification Number ,1/24/2011 11/24/2011 =0 9. - a. Project Start Date (m b. E ad Date (m/ dd/ ) myyyy o _m/dd/yyyy) _ i7A-4P (— __ i_N - c. Work hours Mon -Fri. _ d. Work hours Sat -Sun. ®o 10. a. What type of project is this? �o,, Demolition ,✓ ;Renovation I Repair I Other, please specify: b. Describe �T 11. a. Check abatement procedures: C [ j Glove bag ; Encapsulation �o ( Enclosure 1 Disposal only �U_ ] Cleanup (71 Other, specify: N EGAIR/POLYEN CLOSURE --� 1 Full containment b. Describe --z �Q 12. Is the job being conducted: ✓' Indoors? Outdoors? anf001ap.doc• 10/02 /0 0 1 -Dour Asbestos Notification Form • Page 1 of 3 A LlCommonwealth of Massachusetts Asbestos Notification Form ANF -001 10011920_7 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: 0 200 a. Total pipes or ducts (linear ft) -6. Total oth6 surfaces (square ft) c. Boiler, breaching, duct, tank j surface coatings Lin. ft. Sq. ft.' d. Insulating cement Lin. ft. Sq. ft. e. Corrugated or layered paper pipe insulation Lin. ft. Sq— ft. f. Trowel/Sprayer coatings Lin. ft. Sq. ft. g. Spray -on fireproofing - - h. Transite board, wall board f 200 Lin. ft. 'Sq . ff. Lin. ft. Sq. ft. 1. Cloths, woven fabrics I- J J. Other, please specify: Lin ft Sg, ft. Lin_.,t. Sq. ft. k. Thermal, solid core pipe I I I IL insulation Lin. ft. Sq. ft. 1. Specify 14. Describe the decontamination system(s) to be used: THREE STAGE 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): _ _ _ _ __ MATERIALS WILL BE WETTED AND PLACED IN DOUBLE BAGS AND LABELED FOR TRANSP 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: `a. -Nam -e of DEP Offi6ai tb. Title c. Date (mm/dd%yyyy) of Authorization d. DEP Waiver # L __ e. Name of DOS Official f. DOS Official Title _ g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # N �0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? _ . Yes ;✓ No _0 B. Facility Description �0 1. Current or prior use of facility: R&D MANUFACTURING o 2. Is the facility owner -occupied residential with 4 units or less? � ]Yes `✓: No =r 4ROHM $ HAAS ELECTRONIC MATERIALS j 60 WILLOW STREET 3' ar Facility Owner Name T b. Address o _ _ ,NORTH ANDOVER 01845 978-689-1507 o c. City/Town _ d. Zip Code N e. Telephone Number (area code and extension) �u 4 RANDALL GOY_E_TT_E _ SAME AS ABOVE z a. Name of Facility Owner's On -Site Manager b. On -Site Manager Address � z _ _ __ _ ___ _ _. _ _ _ I r— _ , Q c. City(rown d. Zip Code j e. Telephone Number (area code and extension) ■ anf001ap.doc • 10/02 Asbestos Notification Form • Page 2 of 3 D . Commonwealth of Massachusetts ■ 100119207 i Asbestos Notification Form ANF -001 Decal Number N The undersigned hereby states, under the penalties of perjury, that he/she has read the �o Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and �T 310 CMR 7.15, and that the information ® contained in this notification is true and correct to the best of his/her knowledge and belief. 0 amu_ -Z ffi�-NQ ■ anf001ap.doc • 10/02 ,BRENT MORGENST_ERN a. Name ESALES c. Position/Title 784702860 e. Telephone Number _ 5 CONCORD STREET NORTH_READING _ h. City/Town Brent Morgenstern b. Authorized Signature 1 /7/2011 _ d. Date_(mm/d(4/vvvv)_ DEC -TAM f. Representing 01864 i. Zip Code Asbestos Notification Form • Page 3 of 3 B. Facility Description (cont.) 5' a. Name of General Contractor c. City/Town -d. Zip Code ZURICH AMERICAN f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? b. Address e. Telephone Number (area code and extension) WC488324701 12/28/2011 g. Policy Number h. Exp. Date (mm/dd/yyyy) ;30,000__ 1 - - a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 4. Transporter of asbestos -containing material from site to temporary storage site (if necessary): Note: Transfer a. Name of Transporter _ b. Address., Stations must E comply with the c. City/Town d. Trp Code e. Telephone Number Solid Waste Division 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT �58 PYLES LANE - _ ' a. Name of Transporter b. Address NEW CASTLE, DE 119720 8779999559 __. _ _ Cityactwn d. Zip Code - ^ e. Telephone Number Cc` a. Refuse Transfer Station and Owner b. Address ted. Zip Code c_CitylTown e. Telephone Number _ __ _ 4. ENTERPRISES INC _MINERVA a. Final Disposal Site location Name b. Final Disposal Site Location Owner's Name 9000 MINERVA ROAD W NYA ESBURG_ _ c. Final Disposal Site Address OH-- _ _ _ _ - w_ _._ _ _ . _ _. 44688 v _ �C0 e. State f. Zi Code Zip g. Telephone Number �o =a D. Certification N The undersigned hereby states, under the penalties of perjury, that he/she has read the �o Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and �T 310 CMR 7.15, and that the information ® contained in this notification is true and correct to the best of his/her knowledge and belief. 0 amu_ -Z ffi�-NQ ■ anf001ap.doc • 10/02 ,BRENT MORGENST_ERN a. Name ESALES c. Position/Title 784702860 e. Telephone Number _ 5 CONCORD STREET NORTH_READING _ h. City/Town Brent Morgenstern b. Authorized Signature 1 /7/2011 _ d. Date_(mm/d(4/vvvv)_ DEC -TAM f. Representing 01864 i. Zip Code Asbestos Notification Form • Page 3 of 3 MassDEP Horne I Con'ac> i Feedback t Tour i Privw-y Policv MassDEP's Online Filing System My eDEP F'ormsvz My Ptofiles_! Bella l Receipt Fnrrns Siq ature Payment Receipt Summary/Receipt not recei t �.P p Exit V Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 359711 Date and Time Submitted: 1/7/20114:08:55 PM Other Email: Form Name: AQ 04 -Asbestos Removal Notification Form ANF -001 Payment Information DEP code: 51903 Date: 1/7/2011 4:08:39 PM Amount ($): 85 Billing Info: Paleo Janice—AccountType — AccountNumber ****6000 ConfirmationNumber: Contractor Contractor Number: AC000035 Name: DEC -TAM CORPORATION Address: 50 CONCORD STREET, NORTH READING, MA 01864 978-470-2860 Supervisor GEORGE A. PAGE Project Monitor Lab Location LAB#1 ORGANICS R&D Project Start Date 1/24/2011 Usemame:DECTAM Niclmame: DECTAMEDEP Mv.gDEP MassDEP Hume I Contact I Feedback i Tozrr i Prive y Policy MassDEP's Online Filing System ver.9.9.9.00 2010 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 1/7/2011 Cl) CO }im% . 7 6C4 q \kkk kE LU \] \& 22 t2 w\ 7( z� ®� ƒ� w a .G k§ kk . �u R%§§ L 2 %§gam � I)k \ Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. a, a� INSTRUCTIONS Commonwealth of Massachusetts 1100116922 Asbestos Notification Form ANF -001 Decal Number A. Asbestos Abatement Description 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied residence of four units or less? F-1 Yes f ✓1 Nn 2 3 1. All sections of this form must be completed in order to comply with 4. DEP notification requirements of 310 CMR 7.15 5• and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 b. Provide blanket decal number if applicable - Facility Location: JROHM-HAAS a. Name of Facility NORTH ANDOVER I IMA c. City/Town d. State Blanket Decal Number 60 WILLOW STREET b. Street Address _ 01845 J 19786891507 e. Zip Code f. Telephone Number Worksite Location: LAB #1/MAINTSHOP/LAB11] I ACID WASH a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room Is the facility occupied? ✓❑ Yes ❑ No Asbestos Contractor: DEC -TAM CORPORATION a. Name NORTH READING —� 01864 c. Cit /Town d. Zip Code AC000035 f. DOS License Number BRENT MORGENSTERN 6 (GEORGE A. PAGE a. Name of On -Site Supervisor/Foreman URS 7' a. Name of Project Monitor URS 8' a. Name of Asbestos Analytical Lab 9. 12/6/2010 a. Project Start Date(mm/qg&yyyJ 7A -4P c. Work hours Mon -Fri. 10. a. What type of project is this? ❑ Demolition ✓❑ Renovation ❑ Repair ❑ Other, please specify: 11. a. Check abatement procedures: ❑ Glove bag ❑ Enclosure ❑ Cleanup ❑ Full containment ❑ Encapsulation ❑ Disposal only ❑✓ Other, specify: 50 CONCORD STREET b. Address 9784702860 e. Telephone Number g. Contract Type: ❑✓ Written ❑ Verbal 933 0175 0175 112/10/2010 b. E nd Date mm/ dd/ d. Work hours Sat -Sun. b. Describe NEGAIR/POLYENCLOSURE b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? anf001ap.doc • 10/02 _ D l Asbestos Notification Form •Page 1 of 3 lo'o eD P Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) 100116922 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: _ 10 1 12400 -----� a. Total pipes or ducts (linear ftbio a other surfaces square c. Boiler, breaching, duct, tank 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: surface coatings Lin. ft. e. Corrugated or layered paper SqL� pipe insulation Lin. l.�g. Spray -on fireproofing Lin. ft. h. Transite board, wall board h. DOS Waiver # i. Cloths, woven fabrics Lin k. Thermal, solid core pipe Sq. insulation Lin. ft. 14. Describe the decontamination system(s) to be used: THREE STAGE I. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14121(a): IMATERIALS WILL BE WETTED AND PLACED IN DOUBLE BAGS AND LABELED FOR TRANSP I 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: d. Insulating cement Lin. SqL� c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # f. Trowel/Sprayer coatings Lin. ft. Sq. ft. h. Transite board, wall board h. DOS Waiver # 2400 Lin. ft. Sq. 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes p✓ No F� In. j. Other, please specify: ft. So. ft. I. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14121(a): IMATERIALS WILL BE WETTED AND PLACED IN DOUBLE BAGS AND LABELED FOR TRANSP I 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a. Name of DEP Official b. Title c. Date (mm/dd/yyyy) of Authorization d. DEP Waiver # e. Name of DOS Official f. DOS Official Title g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # �N �0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes p✓ No B. Facility Description N R8D MANUFACTURING to 1. Current or prior use of facility: �o 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes 21 No ROHM 8 HAAS 60 WILLOW STREET 3' a. Facility Owner Name b. Address o NO ANDOVER 101845 978-689-1507 C) c. Cit /Town A. Zip Code e. Telephone Number area code and extension RANDALL GOYETTE � SAME AS ABOVE � 4' a. Name of FacilityOwner's On -Site Manager b. On -Site Manager Address z Z Q c. City/Town d. Zip Code e. Telephone Number (area code and extension) anf001ap.doc • 10/02 Asbestos Notification Form • Page 2 of 3 Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 �O �N �o �o 0 �o u_ MMMMMMMMMZ �Q Commonwealth of Massachusetts Asbestos Notification Form ANF -001 B. Facility Description (cont.) a. Name of General Contractor r c. Cit /Town d. Zip Code ZURICH AMERICAN f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? 100116922 Decal Number C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): a. Name of Transporter ll c. City/Town d. Zip Code 2. Transporter of asbestos -containing waste material (SERVICE TRANSPORT b. Authorized Signature b. Address 19720 d. Zip Code 3. d. Date (mm/dd/yyw) a. Refuse Transfer Station and Owner c. Cit /Town e. Telephone Number area code and extension WC48832470_ 12/28/2010 g. Policy Number h. Exp. Date (mm/dd/yyy 30000 R a. Square Feet b. Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): a. Name of Transporter ll c. City/Town d. Zip Code 2. Transporter of asbestos -containing waste material (SERVICE TRANSPORT b. Authorized Signature a. Name of Transporter NEW CASTLE, DE c. Cit /Town 19720 d. Zip Code 3. d. Date (mm/dd/yyw) a. Refuse Transfer Station and Owner c. Cit /Town d. Zip Code 4. IMINERVA ENTERPRISES INC f. Representing a. Final Disposal Site Location Name 9000 MINERVA ROAD c. Final Disposal Site Address OH e. State 44688 f. Zip Code D. Certification The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. anf001 ap.doc • 10/02 b. Address e. Telephone Number from removal/temporary site to final disposal site: 158 PYLES LANE b. Address e. Telephone Number b. Address Owner's IWAYNESBURG Number BRENT MORGENSTERN Brent Morgenstern a. Name b. Authorized Signature SALES 11/18/2010 c. Position/Title d. Date (mm/dd/yyw) 9784702860 1 IDEC-TAM e. Telephone Number f. Representing 50 CONCORD STREET a. Address NORTH READING�� 01864 h. City/Town i. Zip Code Asbestos Notification Form • Page 3 of 3 DEC -TAM CORPORATION Specialty Contractors November 18, 2010 North Andover Board of Health 1600 Osgood Street Building 20, Suite 2-36 978.470.2860 fax 978.470.1017 NOV 2 3 2010 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: Rohm -Haas, 60 Willow Street, North Andover, MA 01845 (Lab #1/ Maintenance Shop/ Lab 11) Dear Sir or Madam: Please be advised that Dec -Tam Corporation will be performing an asbestos abatement projects at the above referenced locations. This work has been scheduled for December 06, 2010 to December 10, 2010 All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Brenton Morgenstern Sales Estimator BM/cam Enclosure Environmental Remediation Services • Surface Preparation • Facilities Services 50 Concord Street • North Reading, MA 01864 • www.dectam.com • solutions@dectam.com f July 15, 2011 Sandra Starr North Andover Health Department 30 School Street North Andover, MA 01845 JUL 2U 20 TOWN OP NORTH ANDOVP Subject: North Andover Contingency Plan Revisions Dear Ms. Starr, The Rohm and Haas Electronic Materials (North Andover, MA) con ' p a`n Fi s been updated to reflect the facility's current contact information for facility personnel. In keeping with state and federal regulations, we have enclosed the revised sections of the plan. Please update your copy of the plan with these pages (removing the complete Sections 1 and 2, and replacing with the enclosed). If you have questions, please feel free to contact the Rohm and Haas North Andover facility (978) 557 / 7oa ROHM AND HAAS CONTINGENCY PLAN J6 July 15, 2011 Page 2 of 2 Attachment 1 Contingency Plan Sections 1 and 2, Rohm and Haas North Andover Plant ROHM AND HAAS CONTINGENCY PLAN x SECTION 1 North Andover Facility Emergency Emer enc Call List NORTH ANDOVER FACILITY EMERGENCY PAGE SYSTEM 59 NORTH ANDOVER FACILITY COMMAND CENTER (978) 689-0923 IN CASE OF ANY EMERGENCY (Call in order listed) Julie Thyne (North Andover Site Leader) Home: (978) 455-4128 HOSPITALS: (Lawrence General Hospital Emergency Room) Cell: (989) 941-8522 Gardner Peters (North Andover Facility Manager) Home: (978) 779-2212 EMERGENCY COORDINATOR, ALTERNATE Cell: (774) 245-1384 Craig Nelson (Metalorganics Production Supervisor) Home: (978) 474-5073 Cell: (978) 815-5024 Ken Twining (EH&S Delivery Technician) Home: (603)577-5487 EMERGENCY COORDINATOR Cell: (978) 360-9920 IN CASE OF MEDICAL EMERGENCY NORTH ANDOVER AMBULANCE: 8-911 HOSPITALS: (Lawrence General Hospital Emergency Room) (978) 683-4000 Ext. 2500 (Holy Family Hospital Emergency Room) (978) 687-0156 Dial 0 OCCUPATIONAL DOCTOR: (Quadrant Medical) (978) 532-2428 OSHA OFFICE: Normal hours: (617) 565-8110 After hours/holidays: (800) 321 -OSHA IN CASE OF FIRE EMERGENCY NORTH ANDOVER FIRE DEPT: 8-911 SECURITY TEAM: (Fire Alarm System Repairs) (978) 465-5000 SECURITY TEAM: (Fire Alarm System Monitoring) (800) 639-2066 La C C IN CASE OF CHEMICAL SPILL OR RELEASE TRANSPORTATION EMERGENCY: (CHEMTREC) (800) 424-9300 MAJOR SPILL EMERGENCY: (National Response Center) (800) 424-8802 DEPARTMENT OF ENVIRONMENTAL PROTECTION: 9am-5pm: (978) 694-3200 After hours: (888) 304-1133 CLEAN HARBORS: (Spill Response) (800) 645-8265, (718) 792-5000 GREATER LAWRENCE SANITARY DISTRICT: (WWT) (978) 685-1612 BAY STATE GAS: (Leaks) (800) 525-8222 LEPC CHAIR: (N. Andover Fire Chief s Office) (978) 688-9590 IN CASE OF SECURITY EMERGENCY NORTH ANDOVER POLICE: 8-911 o(978) 683-3168 MINUTEMAN: (Security Alarm System Repair) (978) 783-0018 MINUTEMAN: (Security Alarm System Monitoring) (800) 933-6543 BUREAU OF ATF: (Bomb Threats) (888) 283-2662 IN CASE OF OTHER EMERGENCIES MASSACHUSETTS ELECTRIC: (Power Outage) (800) 465-1212 LOCAL BOARD OF HEALTH: (978) 688-9540 DOW CORPORATE CRISIS MANAGEMENT TEAM" (989) 636--4400 *See Appendix G for guidance on Dow Corporate Management Team correspondence. 57 SECTION 2 Emergency Response Incident Command System There are three major components of the emergency response incident command system: emergency coordinator (EC), environmental health and safety department, and facility employees. Emergency Coordinators If an incident occurs, which requires implementation of this plan, the overall responsibility of coordinating all on -scene emergency response measures rests with the EC. The name, address and phone number of the EC and alternates is presented on the following pages. These individuals are familiar with all aspects of the facility's contingency plan, all operations and activities associated with the facility, the location and characteristics of waste materials used and handled at the facility, the location of facility records, as well as the facility layout. In addition, these individuals have the authority to commit the resources necessary to carry out this plan. The EC will assess possible hazards to human health or the environment which may result from a release, fire, or explosion, considering both direct and indirect effects of the release, fire, or explosion. If the EC finds there are hazards to human health or the environment, he/she must notify local authorities and government officials immediately. Environmental, Health, and Safety Department The Environmental, Health, and Safety (EHS) Department is responsible for ensuring all environmental regulations are being met and in the event of a release to the environment that the appropriate cleanup procedures are used and, if appropriate, the proper notifications are made. It is also the EHS Department's responsibility to assist the EC when a release or a threat of a release of hazardous materials to the environment exists. The EHS Department will ensure recovered waste, contaminated soil or surface water, or any other material that results from a release, fire, or explosion at the facility is stored and disposed of according to all applicable regulations. All Employees The responsibility of maintaining a safe and clean work environment rests with all employees. All employees have been trained on the elements of this plan and have been instructed who to notify in case of a fire, explosion, or spill in their work area. Emergency Coordinator Listing Refer to Section 1, North Andover Facility Emergency Call List, for the names and phone numbers of the Emergency Coordinator and Alternate Emergency Coordinator. U Cd I"%. UJ d. N Cm O C C � a _m �N O t. N m CD 0 p �• � O � H O O cc 21,Z o a 0 m � 1=2 m C ip CD W �m�m �¢ = U .E CS -o C N w W W O H �O 93OL m 4- CLO m W as U b o b :J U W m . 8 o aZ C p G p G p C CQ cn v) I"%. UJ d. N Cm O C C � a _m �N O t. N m CD 0 C_ O Q d C t O O cc 21,Z o a 0 m � 1=2 m C CD CD a«=.O �m�m c = .E CS -o C N C3 Of CL H �O 93OL m 4- CLO m d N Me 0 N C O W Of CD cm C 00 0 cm c .E N O t O Z 0 g O F. f c rm U O 0 �F..t a co O E 0 L 0 Z co O. O CA C C cm CO2O C _ y C �= m m CD C3 L CL -676 a CL CMQ c o c Cc C.3 J 'a C Z CD 0 CL C.3 h c C C c d CO2 D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 0 Y CERTIFY THAT THE BUILDING CONSTRUCTED AT 60 Willow Street - HVAC Improvements TO THE BEST OF MY KNOWLEDGE AND BELIEF & IN MY PROFESSIONAL OPINION, DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: REGISTRATION. `iG04 / C1 NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Form revised 11. 15.2004 ,11R OF JAMES IvC. gWOLAHAN No. 31610 STRUCTURAL LO-Z SS�ONAL Ep6 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - MECHANICAL July 16, 2009 Building Inspector Town of North Andover 400 Osgood Street C j North Andover, MA 01845 In accordance with Section 1.1.0 and 116.0 of the Massachusetts State Building Code, I, Steven A. Karan, PE, LEED AP, Reg#: 34989, hereby certify that the Building constructed at 60 Willow. Street — HVAC Improvements does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Company Name: Company Address: State Registration: Telephone Number: Steven A. Karan, PE, LEED AP Building Engineering Resources, Inc. 28 Main Street, Bldg. #3A — North Easton, MA #34989 (508) 230-0260 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta, Building Commissioner July 16, 2009 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax(978)688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - ELECTRICAL Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I , Marc R. Plante, PE, Reg#: 38119, hereby certify that the Building constructed at 60 Willow Street — HVAC Improvements does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Marc R. Plante, PE Company Name: Building Engineering Resources, Inc. Company Address: 28 Main Street, Bldg. #3A — North Easton, MA State Registration: #38119 Telephone Number: (508) 230-0260 MARC R. PLANTE ELECTRICAL Wo. 38119 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - PLUMBING July 16, 2009 Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I, Steven A. Karan, PE, LEED AP, Reg#: 34989, hereby certify that the Building constructed at 60 Willow Street — HVAC Improvements does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Company Name: Company Address: State Registration: Telephone Number: Steven A. Karan, PE, LEED AP Building Engineering Resources, Inc. 28 Main Street, Bldg. #3A —North Easton, MA #34989 (508) 230-0260 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta, Building Commissioner July 1.6, 2009 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING — FIRE PROTECTION t, Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I , Steven A. Karan, PE, LEED AP, Reg#: 34989, hereby certify that the Building constructed at 60 Willow Street — HVAC Improvements does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Company Name: Company Address: State Registration: Telephone Number: Steven A. Karan, PE, LEED AP Building Engineering Resources, Inc. 28 Main Street, Bldg. 0A — North Easton, MA #34989 (508) 230-0260 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 CERTIFY THAT THE BUILDING CONSTRUCTED AT 60 willow Street - HVAC Improvements TO THE BEST OF MY KNOWLEDGE AND BELIEF & IN MY PROFESSIONAL OPINION, DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: NIPMV�IWR I REGISTRATION: (� NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Form revised I L ] 5.2004 0P-1 G. TR 0 C, No. 6011 p `� NATICK, W 3Q MASS. �Jy rN of 0 BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 9 Location' No. Date NORTh TOWN OF NORTH ANDOVER O F 9 TV, } ^ : Certificate of Occupancy $ Its ',kMus t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Z Check' `^i� //Ox/ Building Inspectbr� ' 111O1704L111 1:21137L2271: 8002089291'' A v Z O T T I.L O J Q J � � ir O aQ O Z CL 0 N Date.....k....k - . -. ey . 2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ............................................. has permission to perform,..(..-: wiring in the building of ... . .... at ............. ... ...................... North Andover, Mass. Fee/cQ3... . ..... Lic. No/7/6/ . .............. ..... ELEcTRicAL Check # ",VNKM AV Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �J �yd BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrica*Insecftor C), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:09 City or Town of: NORTH ANDOVER To the of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_j 0 l.✓ I ( to C4-, .K� Owner or Tenant 00 LA/ Owner's Address J Mf— Is this permit in conjunction with a building permit? Yes Purpose of Building C >P Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters t Ve,Itr. -e 'rotirtlC01 w1r1H g HI/ /% C No. of Recessed Luminaires �ieeJuuawtn No. of Ceil: Susp. (Paddle) Fans ranee may oe waived by the Inspector of Wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above In- g ❑grnd. o. o Emergency ig g d. Battea Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons Alerting Devices No. of Waste Disposers Heat Pum Number _ Tons KW Self -Contained Totals ....._.._........ _ _._.Devices tDetiection/Aleirting No. of Dishwashers Space/Area Heating KW ❑ Municipal El Other Connection No. of Dryers Heating Appliances K, Security Systems: No. of WaterNo. N o.of No. of Devices or Equivalent Heaters I of Si s Ballasts Data itin . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /�00 (When required by municipal policy.) Work to Start 09 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete - FIRM NAME: vL /e i C �itll LIC. NO.: /7 Licensee: CTI re`s-fWiter 60,`R, -"gCif Signature LIC. NO.: (If applicable, enter "exempt " in the license nuptber line.) Bus. TeL No.: — T Address: �� /1!`S'� �N e� r, fI1 agsfipa,� t-0 /¢ Alt. Tel. No. 7 (-9/a_ta?/ *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: $5� `� f F_7 A The Commonwealth of Massachusetts 1 Department of industrial Accidents z#1 Office of Investigations 600 fflashington Street ;'� i Boston, MA 02111 www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Pieas-Print Lem'bly Name (Business/Organization/Individual);QL t� GGA►^ t c �W �. Address: Me City/State/Zip:_(� yr ,ISO h - !M 19- ��6y Phone #:. Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demoiition 9. (] Building addition 10.0 Electrical repairs or additions 1 I •❑ Plumbing repairs or additions 12.❑ Roof repairs 13-M Other g pensatcon poesy mtormataon. homeowner¢ who submit this check this box ai�davit indicating they are doing all work and then hire outside Contractors that contractors must submit a new affidavit indicating such. roust attached an additions] sheet sftawirrg ecce name of the sub -contractors and their workers ` comp, policy information. I am an employer that is providing workers' compensation insurance for my employeeL Below is the information. policy and job site Insurance Company Name:_T,, v" lel S Policy # or Self -ins. Lie. #: tJ Q /0 5-0 ifi 5-7 O E —0-7 Expiration Date: / O Job Site Address: -66 //a w City/State2i /� �t 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 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 v r e paid penalties of perjury that the information provided above is true and correct Date.- Phone ate.Phone #: ficial use only. Do notwrite 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 #: Are you an employer? Cheek.tbr appropriate box: - L lqlam a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ I am .a.sole proprietor or have hired the sub -contractors listed I partner- ship and have no employees on the attached sheet. These sob -contactors have working for mein' any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No-worke'rs' comp. c. 1.52, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] *Any applicant that checks bob # I must also fill out the section blow showin their workers' coin Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demoiition 9. (] Building addition 10.0 Electrical repairs or additions 1 I •❑ Plumbing repairs or additions 12.❑ Roof repairs 13-M Other g pensatcon poesy mtormataon. homeowner¢ who submit this check this box ai�davit indicating they are doing all work and then hire outside Contractors that contractors must submit a new affidavit indicating such. roust attached an additions] sheet sftawirrg ecce name of the sub -contractors and their workers ` comp, policy information. I am an employer that is providing workers' compensation insurance for my employeeL Below is the information. policy and job site Insurance Company Name:_T,, v" lel S Policy # or Self -ins. Lie. #: tJ Q /0 5-0 ifi 5-7 O E —0-7 Expiration Date: / O Job Site Address: -66 //a w City/State2i /� �t 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 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 v r e paid penalties of perjury that the information provided above is true and correct Date.- Phone ate.Phone #: ficial use only. Do notwrite 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 #: ti 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are 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 r be returned to the city or town that the application for the permit or license is being requested, notthe 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 numberlisted 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 policyinformation (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. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-77451 www.mass.gov/dia TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that1..1.-r ..... .c�...t�'..� has permission to perform . ?;.���,,-...:.y.......................... .......:......... wiring in the building of .,....... . J.;...e-- at ..4,.G?.... � Z//P..I.....�...�................................... . Nort dover, Mass. FeeQ1.154-X Lic. No. �. ....Sk.g.'g........ ! ELECTRICAL NSPECroR Check # 65 1, 3 Commonwealth of Massachusetts Official Use Only. a Permit No. �'-VVF Department of Fire Services Occupancy and Fee Checked e BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/30/09 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) 60 Willow Street Owner or Tenant Rohm and Haas Electronic Materials Telephone No. Owner's Address 60 Willow St–North Andover MA Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Lab Renovation Utility Authorization No. ITdgrd •i ndgrd ❑ Date . ` �,.........n�........... TOWN OF NORTH ANDOVER PERMIT, FOR WIRING No. of Meters 2 No. of Meters r laboratory spaces. Upgrade of HVAC and ns a ation of new generator asso- table may be waived by the Inspector of Wires. sAcHus�� Generators KVA No. of Emergency Lighting ` Batter Units This certifies that �. w •.. FIRE ALARMS I No. of Zones has permission to perform . t` �•.i + ll-� - No. of Detection and r ""/:':""" Initiatin Devices wiring in the building of../.. —o.bvr-.1 ...te4 P ....... ..a i?. �.1 ��.!' ' % , -- No. of Alerting Devices / No. of Self -Contained at ..tee.(1....G / f•l......................................... , Nort dover, Mass. Detection/Alerting Devices d Fee';�.tJ-6. ..71`- Lic. No.`s��.... / +. .t `........ Local ❑ M nnici iPl on Elother 1 ELECTRICAL NSPEC4 / Security Systems:* Check IlL No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. of Devices or Equivalent I OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 150,000.00 (When required by municipal policy.) Work to Start: 1/26/09 Inspections to be requested in accordance with MEC 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 ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is tru and com tete. FIRM NAME: Piauette and Howard Electric Service � i _ / LIC. O.: MR392 Licensee: Robert B Howard Signature C. NO.: (If applicable, enter "exempt" in the license number line.) -tJBus. Tel. No.: 603-382-3182 Address: 222 Plaistow Rd – Plaistow NH Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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. f pwsl�-, Date.....P .....17..x! .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Zzi. l,r 0 This certifies that .......... .................... has permission to perform ....... ................... wiring in the building of ...... at �XJ 10 ........................ ................................ North Andover, Mass. Fee V� Lic. No. ............. 421:i ... ....... ELECTRICAL INSPECTOR Check, /0'7_3 85,/o ` Commonwealth of Massachusetts Official Use Only ' Department of Fire Services Permit No. �. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/30/09 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) 60 Willow Street Owner or Tenant Rohm and Haas Electronic Materials Telephone No. Owner's Address 60 Willow St — North Andover MA Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Lab Renovation Utility Authorization No. Existing Service 3000 Amps 277/480 Volts Overhead ❑ Undgrd ® No. of Meters 2 p, New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New lighting and power for laboratory spaces. Upgrade of HVAC and exhaust system including a new 800A distribution panel to support new equipment. Installation of new 15OKW generator asso- ciated transfer switch and distribution. Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. El o. o Emergency Lighting Units No. of Receptacle Outlets 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 No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number TonsKW ..... """ ""............... No. of Self -Contained Detection/Alerting 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 Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 150,000.00 (When required by municipal policy.) Work to Start: 1/26/09 Inspections to be requested in accordance with MEC 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 ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is tru and com tete. FIRM NAME: Piquette and Howard Electric Service i _ / LIC. O.: MR392 Licensee: Robert B Howard Signature MIX (If applicable, enter "exempt" in the license number line) I Bus. Tel. No.: 603-382-3182 Address: 222 Plaistow Rd — Plaistow NH v Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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: $ 41 Enter construction cost for fee cal North Andover Fee Calculation Construction Cost $ 15410,500.00 Building Fee $ 16,926.00 Plumbing Fee $ 2,115.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 2,115.75 Total fees collected $ 21,257.50 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............! '. ............................................................................... has permission to perform t�.".........................'.......... wiring in the building of ..........}:::":':...� '..................................................... .� � / .. at .................... Of.......:'.`........... �-1! .,.... ,North Andover, Mass. �r.......... Fee ....... ....... Lic. N6�'J .' ��' ................. ... ............. / ELECCRICAL INSP GTO o- Check # 6JJJ N Commonwealth of Massachusetts Official Use Only lug Department of Fire Services Permit No. Occupancy and Fee Checked 0 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/18/09 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) 60 Willow St Owner or Tenant Rohm and Haas Electronic Materials Owner's Address 60 Willow St North Andover MA Telephone No. Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropri to Box) Purpose of Building Small Lab Renovation Utility Authorization No. Existing Service 3000 Amps 480/ 277 Volts Overhead ❑ Undgrd ® No. o Meters 2 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Small materials and storage area shall be reconfigured with new fume hoods and power. Fixtures shall be re-lamped and re -ballasted. Completion of the following table maybe waived by the In ector o Wires No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above EJIn- d. Elo. rnd. rn o Batter Units Units cy ig mg No. of Receptacle Outlets 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 No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Number ... "'."' Tons """"""""""' KW " ' No. of Self -Contained Totals Detection/Alerting Devices No. of Dishwashers. Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers HeatingAppliances Kms' PP Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of 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 Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 3/23/09 Inspections to be requested in accordance with MEC 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 ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application ' tru d complete. FIRM NAME: Pi uette and Howard Electric Service Inc. LIC. NO.: Licensee: Robert Bruce Howard Signature LIC. NO.: (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 6033823182 . Address: 222 Plaistow Rd — Plaistow NH 03865 Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. (" �, JPL-e- 0 m z CL h O H O CL iii c O CD Q _cc ZL h O C3 .Q y cc C O V C _cc CL COD W C=m O C o� m m Cl H .CD as o� C2 o, CL c< c C O R Z 4D CLy C ul ul U) W W Ix W U) LE U)w° U a�' cn a�' w w7 C/) CO z CL h O H O CL iii c O CD Q _cc ZL h O C3 .Q y cc C O V C _cc CL COD W C=m O C o� m m Cl H .CD as o� C2 o, CL c< c C O R Z 4D CLy C ul ul U) W W Ix W U) 0 z W cd w C pl CD O CD Z O O H L O i ClO 0 am C3 _cc ZE CO) O fl. CA 'O+ V cc C CL h O v CD C. CIO C O CM O C o� CD m m LU 0 LLI 0 cc W W 19 W CD C 0 a.. i:. O C � O Q Ci G: CLC cv ea m C O 0 Em Q nw •• o Ew8 w n cn C pl CD O CD Z O O H L O i ClO 0 am C3 _cc ZE CO) O fl. CA 'O+ V cc C CL h O v CD C. CIO C O CM O C o� CD m m LU 0 LLI 0 cc W W 19 W CD C 0 a.. i:. O C � O Q Ci G: CLC cv ea m C O Al: Em Q •• o `\Ec c a C m u vs me a c E a o 6:3 cm _ m N C 0 o ML a. C m �s �s y m ' cm Co m CSt C3 y O Z C d 0 C C •O Q y m = m 3 O N COD W O .O ++ 'O t t •N O r.. W d.0 C v�vy Z O L3 CD 0 ca O' m O Z eyv CL m> C pl CD O CD Z O O H L O i ClO 0 am C3 _cc ZE CO) O fl. CA 'O+ V cc C CL h O v CD C. CIO C O CM O C o� CD m m LU 0 LLI 0 cc W W 19 W CD TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - PLUMBING June 23, 2009 Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I, Steven A. Karan, PE, LEED AP, Reg#: 34989, hereby certify that the Building constructed at 60 Willow Street — Laboratory Renovations does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Steven A. Karan, PE, LEED AP Company Name: Building Engineering Resources, Inc. Company Address: 28 Main Street, Bldg. #3A — North Easton, MA State Registration: #34989 Telephone Number: (508) 230-0260 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, -Jaf/Jij L�� w l C �I .HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 60 Willow St. Raw Mat' l Storaae/Reclaim Lab TO THE BEST OF MY KNOWLDGE AND BELIEF & IN MY PROFESSIONAL OPINION, DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE.- REGISTRATION: ATE:REGISTRATION: NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Form revised 11.15.2004 OF JAMES M. s WOLAHAN No. 31610 \ STRUCTURAL / �Fs��NAI E�G� BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 D. Robert Nicetta, Building Commissioner = TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978)688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF'NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, CERTIFY THAT THE BUILDING CONSTRUCTED AT 60 willow St. Raw Mat' 1 Storage/Reclaim Lab TO THE BEST OF MY KNOWL`DGE AND BELIEF & IN, MY PROFESSIONAL OPINION, DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: DATE: I 45 �Icqp�_ REGISTRATION: NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM Control Construction Fonn revised IL 15.2004 C. r �rC 0 Q,t Vol j °o �1°No. 6011 oy NA CK MASS, ay rH OF M�SSl�s BOARD Or APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 le Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. !yxp)� /-7-P-,-7— / ................... 5 -/? ct ......... has permission to perform % . ....... 7— wiring in the building of .... . at .... ......5--7 7 ............................. . North Andover, Mass. Fee..C-? JF"-.. Lic............... .... .. . . wnd4l IlaCMICAL INSPECTOR Check # 885'; 01 Commonwealth of Massachusetts Official Use Only -- Permit No. r�- Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 6/29/09 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) 60 Willow St Owner or Tenant Rohm and Haas Electronic Materials Telephone No. Owner's Address 60 Willow St, North Andover MA Is this permit in conjunction with a building permit? #514 Yes ® No ❑ (Check Appropriate Box) Purpose of Building Industrial Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undg d ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Provide a new 225A feed to new roof top mech unit. Completion ofthe following table may be waived by the tnsnertor of Wirp.c No. of Recessed Luminaires 0 No. of Ceil.-Susp. (Paddle) Fans 0 No. of Transformers 0 Total KVA No. of Luminaire Outlets 0 No. of Hot Tubs 0 Generators 0 KVA No. of Luminaires 0 Swimming Pool Above ❑In- ❑ o. o Emergency Lighting 0 rnd. rnd. Battery Units No. of Receptacle Outlets 0 No. of Oil Burners 0 FIRE ALARMS No. of Zones No. of Switches 0 No. of Gas 0 No. of Detection and 0 .Burners InitiatingDevices No. of Ranges 0 No. of Air Cond. l Total 75 Tons No. of Alerting Devices g 0 No. of Waste Disposers 0 Heat Pum Number Tons KW No. of Self -Contained 0 Totals Detection/AlertingDevices No. of Dishwashers 0 Space/Area heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers 0 Heating Appliances Kms, Security Systems:* 0 No. of Devices or Equivalent No. of Water 0 KW No. of No. of Data Wiring: 0 Heaters Si ns Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs 0 No. of Motors 0 Total HP 0 Telecommunications Wiring: 0 No. of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 4/8/09 Inspections to be requested in accordance with MEC 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 ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Pi uette and Howard Electric Service C. NO.: Licensee: Robert B Howard Signature 'LIC. NO.: MR392 (/f applicable, enter "exempt" in the license number line) f Bus. Tel. No.: 6033823182 Address: 222 Plaistow Rd — Plaistow NH 03865 Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ D. Robert Nicetta, Building Commissioner June 23, 2009 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 Telephone (978) 688-95454 Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - MECHANICAL Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I , Steven A. Karan, PE, LEED AP, Rep-#: 34989, hereby certify that the Building constructed at 60 Willow Street — Laboratory Renovations does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Steven A. Karan, PE, LEED AP Company Name: Building Engineering Resources, Inc. Company Address: 28 Main Street, Bldg. 0A —North Easton, MA State Registration: #34989 Telephone Number: (508) 230-0260 vjZ k OF 446 o� STEVEN A. KARAN MECHANICA Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING — FIRE PROTECTION June 23, 2009 Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I , Steven A. Karan, PE, LEED AP, Resz#: 34989, hereby certify that the Building constructed at 60 Willow Street — Laboratory Renovations does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Steven A. Karan, PE, LEED AP Company Name: Building Engineering Resources, Inc. Company Address: 28 Main Street, Bldg. #3A — North Easton, MA State Registration: #34989 Telephone Number: (508) 230-0260 P�ZN OFlv)q S rSTEVEN A. RAN ANICAL Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 LocationJ- P No. ti Date �I C;)"e�, 011 NORTH TOWN OF NORTH ANDOVER ' Certificate of OccupaIp ncy $ I�s •,•E<�' Building/Frame Permit Fee $ s�cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0'-/v 196 22'1 J w CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Permit # 424 (1116/09) Date: July 1. 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 60 Willow Street MAY BE OCCUPIED AS Commercial Fit Un ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Rohn & Hass 60 Willow Street North Andover Ma 01845 Building Inspector Jul 01 09 10:18a RICH 19 M891 bbfd P.j (n P z 0 V) I 1-3 W 19 w w cc \N, A %4 o rid 0 '4 C3 ca - U j 79 E :2 c" r,�, 4u (n P z 0 V) I 1-3 W 19 w w cc cS o C3 ca - Xv c" 5- 2- o `6: co A. :w ca COD CLIB go ID 4:D CDs os R.0 EM M HZ C, CA LLI S 1... = 60 U I CL §LU C.1 4D CL cc (n P z 0 V) I 1-3 W 19 w w cc E9 * H W 2 =moo =mc w z �' N C V S co w_ in m � a m c c o .v � cn H W 2 =moo =mc a � C V C" w_ in .� c c o .v � t o Si ��a y l..i H W 2 ce Q 4D ' m m ow O.0 cc .d 3� m 0CD 0 cc O d �Q v C � m 42 V CL t0 Ci C Mob c y cm Z -d 99SL6999M6 HOlb e9L:Ol 60 l0 Inf Cl) l..i L1�-a s ce Q 4D ' m m ow O.0 cc .d 3� m 0CD 0 cc O d �Q v C � m 42 V CL t0 Ci C Mob c y cm Z -d 99SL6999M6 HOlb e9L:Ol 60 l0 Inf OORTH TOWN OF NORTH ANDOVER pE wl'lo ", ,•� y.. ° OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, '—\R4t n �•*�` Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING - ELECTRICAL June 23, 2009 Building Inspector Town of North Andover 400 Osgood Street North Andover, MA 01845 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I , Marc R. Plante, PE, Reg#: 38119, hereby certify that the Building constructed at 60 Willow Street — Laboratory Renovations does conform in all respects to the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy. Engineers Name: Company Name: Company Address: State Registration: Telephone Number: Marc R. Plante, PE Building Engineering Resources, Inc. 28 Main Street, Bldg. #3A — North Easton, MA #38119 (508) 230-0260 Engineer Signature & Seal BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Date TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING This certifies that ..;l/S'.�'� .G....l �? C ........................ has permission to perform .. L ` r. &9/,— .3. E�`c u�7F.�.... plumbing in the buildings of .. R .04�..7� �� f�..r................ at . <,JJ ..(,L.A t �!^ ... - ............ North Andover, Mass. FeeLic. No.1641 �:'.. ......Q_>:.:(.!.!t-t 1 'PLUMBING INSP CTOR Check # ft MASSACHUSETTS UNIFORM .APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) G NORTH ANDOVER, MASSACHUSETTS Building New n )wners Name7� j-,�q Date ^ 14 _V S of Occupancy 9 S Permit # G y Amount L Renovation 2 Replacement -Q FIA'TURES Plans Submitted yes El No ❑ (Print or type) Installing Company Name ,SCG (C) �� Check one: Certificate Address Corp.—o% % % S' C AJ /[/ 7 El Partner. Busmmss Telephone n FirnVCO. Name of Licensed Plumber. _ Insurance Coverage: Indicate the type of msurance coverage by c ecking the a Liability insurance policy ED Other type Of inderr�ty PPropriate box: Bond El Insurance Waiver. I the undersigned, have been made aware that the licensee of this applicati three insurance on does not have any one of the above Sign re 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 m}f knowledge and that all plumbing work and installations compliance with all pertinent provisions of th Performed under Permit Issued for this application will be in and Chapt 142 of the General Laws. By: . �� re of l rcense 'Trtle i ypeor riumbuig License City/Town — /0 y Mangy oras /I APPROVED Lrcense vumoer ❑ comics um Journeyman The Commnnwealth ofMassachusettc Deparlment Of f Indmtrial Accidents Office of 1nues6b ations 600 Washirivon Street Boston, M4 02111 wwH?. rnass.go>>/dia Workers' Compensation Insurance Affidavit: giWders/Contractors/Electricians/Plumb �Iicanf Information Insurance rs Name (Business/Organizati Win dividual): Address: City/Stat;/Zip:_,bp .0 G �3 Phone #: i Are you an employer? Check the appropriate box: 1. ZJ I am a employer with 4. ❑ I am a a eneral employees (fill and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required_] t C contractor and I have hired the sub -contractors listed On the attached sheet # These sttb-contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised.their right of exemption per MGL C. IS2, § 1(4), and we have no employees. [No workers' P U C3 Type of project (required): 6• ❑ New construction 7. [ Remodeling . 8• ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 110Roof repairs comp. Insurance required] I 13.E] Other *Any eppiicant,thzt checks box # I .must also'fill our the section below showing tit-tr K orkers' compensation poLcy mmrmatton. t Homnowuets wito submit •ibis affidavit ittdicatiag Ute)- att ciaitig r: : at1d, Lher, hir- cutaide can n i iurs mutt ,nfu a new ameiavit indi atin sc� XConttacton thal ehcci; this box'must attached an addLtional sheet showittg tate name.afthe„E cc,a1raciu and their wnri, __. r _, F n. �••�-•ter= `uc cs provuuno' workers' co enation i .-Unnalion. information assurance for ng, employees. Below is theoli P cy and job site Insurance Company Name: Policy # or Self .ins. Lic. #: Expiration Date: Sob Site Address: Attach a copy of tate workers' compensation lie Cid/state/Zip: Policy decla ration page (showing the policy Dumber and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. I S2 can lead to fine up to 11,500.00 and/or one-year imprisonment the imposition of criminal penalties of a as well as civil of up to 5250.00 a day against the violator. Be advised that a copy o penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. py of this statement may be forwarded to the Office of ”- » "`mac' `"e Pumr and penalties of perJu7' that the informafion provided above is true and correct Official use onlp. Do not write in this area, to be .cnmplete'd b cite or town offjrinl City or Town: Issuing Authority (circle one): Permit/License # I. Board of Health 2. Building Department 3. City/T°vvn fi. Other Clerk 4. Electrical Inspector S. Piumbing Inspector Contact Person: Phone #- l "� •K i .�i P7ii � „r - � r; The Commnnwealth ofMassachusettc Deparlment Of f Indmtrial Accidents Office of 1nues6b ations 600 Washirivon Street Boston, M4 02111 wwH?. rnass.go>>/dia Workers' Compensation Insurance Affidavit: giWders/Contractors/Electricians/Plumb �Iicanf Information Insurance rs Name (Business/Organizati Win dividual): Address: City/Stat;/Zip:_,bp .0 G �3 Phone #: i Are you an employer? Check the appropriate box: 1. ZJ I am a employer with 4. ❑ I am a a eneral employees (fill and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required_] t C contractor and I have hired the sub -contractors listed On the attached sheet # These sttb-contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised.their right of exemption per MGL C. IS2, § 1(4), and we have no employees. [No workers' P U C3 Type of project (required): 6• ❑ New construction 7. [ Remodeling . 8• ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 110Roof repairs comp. Insurance required] I 13.E] Other *Any eppiicant,thzt checks box # I .must also'fill our the section below showing tit-tr K orkers' compensation poLcy mmrmatton. t Homnowuets wito submit •ibis affidavit ittdicatiag Ute)- att ciaitig r: : at1d, Lher, hir- cutaide can n i iurs mutt ,nfu a new ameiavit indi atin sc� XConttacton thal ehcci; this box'must attached an addLtional sheet showittg tate name.afthe„E cc,a1raciu and their wnri, __. r _, F n. �••�-•ter= `uc cs provuuno' workers' co enation i .-Unnalion. information assurance for ng, employees. Below is theoli P cy and job site Insurance Company Name: Policy # or Self .ins. Lic. #: Expiration Date: Sob Site Address: Attach a copy of tate workers' compensation lie Cid/state/Zip: Policy decla ration page (showing the policy Dumber and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. I S2 can lead to fine up to 11,500.00 and/or one-year imprisonment the imposition of criminal penalties of a as well as civil of up to 5250.00 a day against the violator. Be advised that a copy o penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. py of this statement may be forwarded to the Office of ”- » "`mac' `"e Pumr and penalties of perJu7' that the informafion provided above is true and correct Official use onlp. Do not write in this area, to be .cnmplete'd b cite or town offjrinl City or Town: Issuing Authority (circle one): Permit/License # I. Board of Health 2. Building Department 3. City/T°vvn fi. Other Clerk 4. Electrical Inspector S. Piumbing Inspector Contact Person: Phone #- Information a .nd 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 h ire, express or implied, oral or written." An employer is defined as `pan individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and includi-n.g the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employingemployees. 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 maim.. -nonce, 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 a r local licensing agency shall withhold tie 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 mf compliance with the insurance coverase required." Additionally, MGL chapter 152, §25C(7) states "Neither 'the commonwealth nor any of its poiiticalsubdivisions 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 comp i<-etely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees otherthan the members or. partners, are not required to carry workers' compensation insurance. If am LLC or LLP does have - employees, a policy is required_ Be advised, that this afiiici<avit may submitted to .the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affiidavit. 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 anyquestions reg2 T -ding the law or if you are required to obtain a workers' compensatiem galley, Please call the Deparnnent at the nu—_d below. Selfur insed companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the afrrdavit is complete and printed leQibiv. 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 appiioant. Please be sure to fill in the pennitliicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in arty given year, need only submit one affidavit indicating currerrt 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 appiicant as proof that a vaiid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a licenses 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 Comrnonwea:lth of Massachusetts Department of Lrudustrial Accidnts. Office of Lavestigatious 600 WashLington Street Boston; MA 02111 Tel, 4 617-727-4900 e= 406 or 1-9 i'7-MASSAFE Revised 5-26=05 Fax 4 617-7-7-7749 www-mass.aov/dia Locations 4 l,,j4z =ez:: ; No. Date 41-62- 0.3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �SSAGMUSEt Foundation Permit Fee $ Other Permit Fee OtAI0 $ LU.,r v Sewer Connection Fee $ Water Connection Fee $ TOTAL / Building Inspector ,/ 67 6 9 Div. Public Works Ilk ❑ M 0 z N F m y w W m f Ir 0 J LL LL 0 W N y Z L y m W W Z u f x O _Z F 0 0 LL LL 0 W N_ m I 3 W Z 0 Z O IJ Z 0 01 z IL O f u < y J fL L < LL 0 O fl: 0 m V V N o I u D 1 1 � Z J < Y M � f Z Z f O O 1 2 2 W W , a m � O m f O 0 i J J_ F O mw LL LL N f W W m f7 O { LL d 1 .i VI UJ W V � W � � Z 2 2 U GAJ D O O OZ 144 F Z W � J l • O z L 0 < v < 0 W z 1 pm IL N 0 W IC < W < � W Z W K I* IL IL my W F- 4 a W » 1 z O u °u 0 u d F L c J J L uF< `V M < J W O W O W W OW V V N o u D 1 1 � Z f 1 M � f Z Z f O O 1 2 2 W W , a m � O m f O 0 i J J_ F O mw LL LL N f W W m f7 O { LL d 1 � 1 .i VI UJ W V � W � � Z 2 2 U GAJ 144 F Z W � J l O v �1 W z 1 pm IL N 0 W IC < W < � W Z W K I* IL IL I ��il II IIII �Iilllil I I 1111111 K O Z 800 d Z= f LL W 0 Z z W LL a� 0 Q � Z IL Q I I j I w r T oc7 < Z(3 W Q W Y s O se o2 �� m 3 0 o 0 _~ 0 0_ Z Z w Q U K p �" w G< i M °C > u O N z 7 G a N p ~ p Z W W V U ] 3 �->Z mQa fwc U �� d0 0 ww JQ��0Qp0 w ,z� ,gyp J J \ JwF3UQ aoc �oc0�-<-�uui O S OC ,-x OO �a=aoz 2 u a0 LL� O<<0� V w S V a N Q^ m O 3 Y Z N .- d O x Q oa[ C9 O W Z I TTT I I I I Z I 0 U N O O 2 Ofz z f OOO O �r~ JiQLLF JLLwVN� ZG O o� Z p9 LL <<O O° lu �► uZ .�fa�mm W�<opc �ZQ O —x2 z;lz Q zO wany LLQ Ov; 2 00OpO O U W N Q O OxWoOYYVZZ\ OOZIi S O OzZ 8 00 Zi x i VQil NmmU 0Vp>Q Q>O V/<O F N S m FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out �this /srection***************** APPLICANT: �� »N 6 / `� r irl s- Cir � Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street /�f%��D(/t�//-" St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department �. Received by Building Inspector Date DEC 2 0 � W A ucn ti E Cl) cG p (i z A CA 0 -c ° LL E C mG CG O W a4X UD z o c p a4 z ^a W dao L v N u z d Liman O W w w v7 zv c) E cn LU y O z 01 O J z O E LL c c •g� 0 o c p Z CD Q ts C N O � y C i;•, C O cmca z O VO C.: co p• C p O y 'E O O m m cn z 0 ow ~ _ U CL � O � O i O O m m O a a CMa y C c � c Ca 1 o c N J � o a� c z z co . o O C- CACA L L Ca "" cm d c a ci z C rm A z N O z Q J y O C N O N -o 67 O y�0 0 '0 cm o' o c C N Q _ C.C� m p m V y O Ci•5Z O r.+ C O CZ cm c Q 0CEO- m C m_,• G O = CD N y c N cv = as •Ve R = • CL= C 'N v� v Z O CD rm co COD = p' Cm O � m CD C H CC Z 0- O.:*E-m i 01 O J z O E LL C oc 0 o s Z CD Q O � y C O cmca z O G co 'OC —_ y 'E O O m m cn z 0 ow ~ _ U CL � O � O i O O O O a a CMa y C c � c Ca v J � CR c z z co O V C- CACA L L Ca a y z C z z Q J OFFICES OF: ^ APPEALS NORTH ANDOVER ;i.�x"�; BUILDING DIVISION OF CONSERVATION HEALTH PL-iNNING PLANNING & COMMUNITY DEVELOPMENT r. KAREN H.P. NELSON, DIRECTOR 120 Main Street North Andover. Massachusetts O 184S (6 1 7) 685=4775 In accordance with/ the provisions of MGL c 40, S 54, a condition of Building Permit Number S6 q is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: C' ��+lrJ— N s -� 4, (Location of Facility) c, ure if Permit Applica /7-`/0-23 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Town of North Andover Office of the Health Department o g`a'' `�' Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 9SsaC►eU Sandra Starr Public Health Director LEGAL NOTICE Telephone (978) 688-9540 Fax (978) 688-9542 In accordance with the Massachusetts General Laws, Chapter 111, Section 31, the North Andover Board of Health at its regularly scheduled meeting on January 24, 2002 revised the well regulations, including the overall format, to be effective immediately. The changes include: The inclusion of additional definitions, setback requirements, construction requirements, water quality parameters, and well abandonment procedures. Copies of the revised regulations can be reviewed at the North Andover Board of Health office located at 27 Charles Street during office hours and at the Town Clerk's office in the Town Hall on Main Street. Gayton Osgood, Chairman Dr. Francis P. MacMillan Dr. John Rizza, Clerk BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER BOARD OF HEALTH WELL REGULATIONS The Board of Health of the town of North Andover, Massachusetts acting under Chapter 111, Section 31 of the Massachusetts General Laws, as amended and with reference to Chapter 40, Section 54 of said General Laws has, in the interest of and for the protection of public health and the environment, established and adopted the following rules and regulations: Section 1. DEFINITIONS 1.1 The word "well" as used in these regulations shall include any pit, pipe, excavation, casing, drill hole or other private source of water to be used for the purpose of supplying potable water in the town of North Andover. This includes irrigation wells. 1.2 The words "water systems" as used in these regulations shall include pipes, valves, fittings, tanks, pumps, motors, switches, controls and appurtenances installed or used for the purpose of storage, filtration, treatment or purification of water for any use whether or not located inside of a building. 1.3 The words "well contractor" as used in these regulations, shall mean any person, association, partnership, company or corporation that installs, constructs or repairs a water system associated with a well. 1.4 The words "non-essential well" as used in these regulations refers to all wells that are not the sole source of potable drinking water for a site, whether residential or commercial. Section 2. REGISTRATION AND PERMITS 2.1 No well of pump contractor shall engage in the construction or repair of any part of a well or water system in the town of North Andover without registering with the Board of Health. Such registrations shall expire at the end of the year in which they were issued unless earlier revoked for cause. A non- refundable fee of $50.00 shall be paid to the town of North Andover. 2.2 No well shall be constructed until a well permit has been issued by the Board of Health. Such a permit shall be applied for by a well contractor registered with the town of North Andover. A non-refundable fee of $50.00 shall be paid to the town of North Andover. 2.3 Appropriate wiring and plumbing permits shall be applied for and issued by the Building Department prior to well construction. 2.4 No building permit shall be issued for the construction of a building which necessitates the use of water therein for a well located on the land where the building is to be constructed, until a well has been installed and the Board of Health has determined that a safe and adequate supply of potable water is available. 2.5 A well form shall be issued along with the well permit to be filled out by the well and pump contractor. Such a form must be filled out accurately and copies kept on file at the Board of Health upon its completion. Forms received which are not representative may be cause for the revocation of the contractor's registration. 2.6 Major renovation or repair of existing wells and/or water systems must be approved by the Board of Health. 2.7 A permit for the construction of a well shall not be issued for any property that currently has reasonable access to the town water system. 2.8 The Board of Health may deny an application for a non- essential well when it is in the interest of public health to do so, as in times of drought. Section 3. WELL SITING 3.1 The location of a well must be within the boundaries of the lot in which it will be in service. 3.2 There shall be a separate well for each building- It shall be constructed up -gradient from all sources of potential contamination and must be located at distances which are to be equal to or in excess of the following; 1) 100 feet from any septic leach field or existing underground storage tanks 2) 75 feet from any septic tank 3) 50 feet laterally from the normal high mark of any water source 4) a minimum setback of 25 feet from all streets, lot lines and driving surfaces. 5) 20 feet from existing building sewers, and underground swimming pools 3.4 The well shall not be placed within a defined wetland or in an area of consistent flooding. Any proposed well located within 100' of a wetland is subject to regulation by the Wetlands Protection Act. The BOH shall receive a copy of written approval from the North Andover Conservation Commission prior to the issuance of a well permit in these cases. Section 4. CONSTRUCTION REQUIREMENTS 4.1 The well contractor shall observe reasonable sanitary measures and precautions in the performance of his work in order to prevent the pollution of contamination of the well. 4.2 Newly constructed wells or wells where repair work has been done shall be thoroughly disinfected before being put into use. 4.3 Every well shall supply adequate water for the purpose for which it is intended and shall give satisfactory evidence of continuing capability to do so. 4.4 Before being approved, every well shall be pump tested by the well contractor (4 hr pump test). The results of the pump test shall be submitted on the well form issued by the Board of Health. A well shall exceed the following flow rates, or it shall be considered inadequate for a single family dwelling. Well Depth Gallons per Minute for Four Hours 0 - 150 5 -,6 150 - 200 4 200 - 250 2 - 3 250 - 300 1 -2 350 and over 1/2 4.5 There shall be a single and separate water system for each dwelling and it shall not be installed or materially altered until the Board of Health is notified. The Board will require a description of the installation or repair to be conducted. Emergency work for repairs or service of existing equipment not amounting to a substantial renovation or overhaul may be done without notification. Appropriate inspections by wiring or plumbing inspectors will be required before final Board of Health approval. 4.6 All pumps, motors and tanks shall be placed on a suitable foundation and all equipment and parts of the system that may require adjustments or service shall be made readily accessible. 4.7 All pump houses, pump or pipe pits and wells shall be designed and constructed so as to prevent flooding and otherwise to prevent the entrance of pollutants or contaminants. 4.8 The Board of Health shall require the installation of all necessary switches, controls and devices, and the satisfactory performance of a pressure and operating test of the system before final approval; the test must demonstrate that the system will deliver adequate pressure and volume consistent with the well and the well requirements. The Board of Health must be given reasonable notice of when the installation is ready for inspection. 4.9 No certificate of occupancy shall be issued until all the provisions of these regulations have been met. The inspections and these regulations cannot be construed as a guarantee by the town of North Andover or its agents that the water system will function satisfactorily. Section 5. WATER QUALITY 5.1 In cases of new construction, the Board of Health shall require the submission of a water analysis report. The report shall include bacterial and chemical evaluations conducted by a laboratory approved by the Board of Health or the Massachusetts Department of Public Health. Laboratories conducting testing must supply a copy of Massachusetts certification as verification that it holds current certification for all types of analysis done on water samples. The submission of a chemical analysis to the Board of Health is required before issuance of a building permit. The bacterial analysis must be conducted after the water system is completely installed. A report must be submitted before the Board of Health will issue final approval. The following minimal parameters must be included in the water analysis. total coliform alkalinity arsenic calcium chloride color copper hardness iron lead magnesium manganese nitrogen (ammonia) * nitrogen (nitrite) * odor pH * potassium sediment sodium sulfate turbidity total dissolved solids * indicates Primary Contaminants Location No. _ Date ? NORTH 01 TOWN OF NORTH ANDOVER i • OL Certificate of Occupancy $ s.,IsEt� Building/Frame Permit Fee $ Foundation Permit Fee $ $ Other Permit Fee TOTAL + Check # 153 / Building InspectO r TOWN OF NORTH ANDOVER BUELDING DEPARTMENT ' APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING I'IIIs Secteon for Oliiclat Use Onlr�a�� If 1�0r BUILDING PERMIT NUMBER: /� ^� DATE ISSUED: —a` OC Q SIGNATURE: Building Commissiom/er/IgVedor ohfuildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Go W t LGO-tAJ S -i' '7t.. f /,' Map Number Parcel Number " � 1 V1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Simply M GL C 40 1.5. Flood Zone Information: 1.8 Sewerage Disposal Sy� em Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record ,Rd AY& � t �r`�s � � 64 W i��0 � Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Mo f- 175 PA % �1,"►t (,L Aal . N4EFNnt Address for Service: OW -1 � 1-� � k V'J'� 919 - 9,11 Signature Telephone s 3.1 Licensed Construction Supervisor Not Applicable ❑ -7 0S.� r . G l"/(, fr N 0 01-� q l 36 Address f License Number f 4 teen Constructi u r: Expiration'Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name', Registration Number Address Expiration Date Signature Telephone I LN 1, l tJ CA, as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury R� L 4�j On )o Prin N� Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be���i Completed by applicant permit 1. Building n 60 0 (a) Building Permit Fee r� t1 Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number t jT t6r ;���{fi, ! Z�1° tlS f� 7}.. } S } � �ti '1 � (Y t.. 7. 31 � T i � ) :, i 4;M1k � � S� fAi t i,,11 f ✓'. i J NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 N 3'm SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Name: Address Signature Telephone L"JJ47 ykp Or44 I — all ) ` 10 —+-'' • C 1 Not Applicable ❑ ` Company Name: boo )19 L G1 Responsible in Charge of Construction �1 r Name: V / Area of Responsibility Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone y r , Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone L"JJ47 ykp Or44 I — all ) ` 10 —+-'' • C 1 Not Applicable ❑ ` Company Name: boo )19 L G1 Responsible in Charge of Construction �1 r i,EN;IC'Y11 1+RQ�I)"tE% {rC;k all applcable; New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: otm,x %x� t�►� tp-tn V4.tom i Off 1cL IA 1 B ❑ ❑ Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ A4 ❑ A-5 ❑ IA 1 B ❑ ❑ B Business ❑ 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory 0 F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 0 R residential ❑ R -I 0 R-2 0 R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: Proposed Hazard Index 780 CMR 34: r�M1f>, ai1F vW'.. .. 7lALl M1.ti BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date I, tJ CAn as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Prin h� Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by permit applicant 1. BuildingO n �0 (a) Building Permit Fee CO�LV Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (•) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number ''� ?- . ..1y�)ii<<r',.�i % #: � :,` � fly E S k y�('S 1t J F 3 �`'f1 'f}4 5 �994��',, [ i"� �1� Y �. b� {�� { : 1,1� J4 Y:i 1' 'F•+ir�)'�i i 4 I i l e �r f 7C+fir �1 f ✓ 4 b S.{. i # % { , pF, t�...�{ b NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr2ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4Y',`"'M1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING _3 ?\kT r,� Y Z r'W k :^1'_ �- ��' �::� � This Section for Official Use Onl BUILDING PERMIT NUMBER: j� ^1 DATE ISSUED: e oC a SIGNATURE: V-G�� Buildin& Commissier/I or qf)Suildinp Date sEmm K 1.1 Property Address: dress: �� ►r [.t o"i � L , 1.2 Assessors Map and Parcel Number. r. Map Number Parcel Number 0. " 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontes ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M G L C 40 54) 1.5. Flood Zone Information 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner o\f, Record 'R� II Name (Print) Address for Service: Signature Telephone 2.2 Authorized Agent Mot 4L R'l l L � e nt p 17S O�o� Address for Service:�,a O18�i 'i -- 917 -- o Signature Telephone 3.1 Licensed Construction Supervisor Address Not Applicable ❑ License Number afJ6104 Expiration' Da etet rccn CIO 1 n _ Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name,_ Registration Number Address Expiration Date Signature Telephone I LN 0 M /X D z O z M 90 O ic r v M r r ^Z P1 FORM U - LOT RELEASE FORM -too INSTRUCTIONS: This form is used to verify that all necessary approvals/permits Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT ri Il KSS PHO1S N =1 LOCATION: Assessor's Map Number -I Q '- I PARCEL SUBDIVISION LOT (S) STREET (CIO W ST. NUMBER CoO USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR CO DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS . UHIVEWAY PERMIT FIRE DEPARTMENT , RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm r TE ` ✓/ze T�omvnw�.cuect�i o�/�iiaacaciivaelta + BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 029136 Birthdate; 03!18%1944 1. Expires: 03/18/2004 Tr. no: 19070 Restricted 00 DAVID L LYNCH -,' " „- 70 RANGEWAY RD`•!•� N BILLERICA MA 01862 Administrator ,r i MIND10110 CERTIFICATE F LIABILITY IN RANCE DATE (MM/DD/YY) 12/27/01 PRODUCER The Rowley Agency, Inc. P.O. Box 511 Concord NH 03302.0511 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURERS AFFORDING COVERAGE INSURED Olde Canal Builders, Inc. 175 Olde Canal Drive Lowell MA 01851 INSURER A: Maine Employers Mutual In INSURER B: Acadia Insurance Company INSURER C: INSURER D: 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 HFGATF I IM)T,S_C�I Q�(j��Q E-BFFkl REDUCFn Ry PAm (`I Awcz INS R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR #2002-0033 01/01/02 01/01/03 EACH OCCURRENCE $ 11000,000 FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE Is 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO #2002-0032 ,1 ; 0'i'7617 OL 01/01/03 COMBINED SINGLE LIMIT $ 1, 000 O00 (Ea accident) BODILY INJURY (Per Person) $ X ALL OWNED AUTOS SCHEDULED AUTOS X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG is B EXCESS LIABILITY 7X OCCUR CLAIMS MADE #2002-0035 01/01/02 01/01/03 EACH OCCURRENCE Is 5,000,000 AGGREGATE is 5,000,000 DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- IOTH- A EMPLOYERS' LIABILITY #2002-0054 (NH) 01/01/02 01/01/03 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSALOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Rohm & Hass DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 60 Willow Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL N. Andover, MA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25-S (7/97) v (a ACORD CORPORATION 19AA 125 ra 1 0 z rA w p cra v O p w i -: v cn O z z A a W or. G O w �°° O r� u G U C ti, U W rn a �w cY. G w W u a W w p w " cn G rs. H a o n: G w W �¢ a a r W cn v o E cn co O w Z O D y MA .E CD O C 0 CD Q m CL CO2 0 v Its GO C C2 C..3 cc C cc C. CO3 O U) w w w co C O C V ` O + CO.i Gi c L 0. 3 .: o C S a �'H I Es -.� _ C2 CJ.,c 5cm t:i CD = CL=1/1 m o E a .■ N •i=_. c H O:m 7 o, o . o m C C N ' C13o iCO �m .o aCDL� LA i > L m �+-Cc, � c , V:cmoc C m ' Ifh O `Z 0 cm Q C d O c Q o m e CIL)� � o = m 0 N N W Z O N O.z C ac -E ci ci E h Z o w m VpmE. c g h d O1 O.0 x a mo = c =�a�m� co O w Z O D y MA .E CD O C 0 CD Q m CL CO2 0 v Its GO C C2 C..3 cc C cc C. CO3 O U) w w w -•-ror u 137.520 M 0 m V) N I V I 11 lj m MMIE- A I A O O 0 N I A N 120.000 142.039 Ln . 46.000. 44.000 46.000 70 ._� 7jL2.5110 46.000 44.000 45.000 M 44.000 46.000. 44.000 46.000 i A A j j A 0 O 0 95.000 rn V O O O IO lz o" b ip z -z m MMIE- A I A O O 0 N I A N 120.000 142.039 Ln . 46.000. 44.000 46.000 70 ._� 7jL2.5110 46.000 44.000 45.000 M 44.000 46.000. 44.000 46.000 i A A j j A 0 O 0 95.000 rn V O O O 0 Ci e Y IL' I Z' � , N O W V N i i N a. V i SHIPLEY ■ - A ROHM AND HAAS COMPANY December 22, 2003 Mr. Dennis L. Bedrosian Water Treatment Plant Town of N. Andover 420 Great Pond Road North Andover, MA 01845 Dear Mr. Bedrosian: 0 Re: Notice of Name Change for: Shipley Company LLC, Metalorganics Division, 60 Willow Street, North Andover, MA 01845 Please be advised that effective February 2, 2004, Shipley Company, LLC located at 60 Willow Street, North Andover, MA 01845 will begin to transact business under a new name that of Rohm and Haas Electronic Materials. The change of business will not result in any transfer of assets or tax identification numbers. Therefore, any notifications should be changed as follows: LISTED NAME ON PERMIT Shipley Company, LLC. 60 Willow Street N. Andover, MA 01845 LISTED OWNER Shipley Company, LLC. 455 Forest Street Marlborough, MA 01752 NEW NAME ON PERMIT Rohm and Haas Electronic Materials 60 Willow Street N. Andover, MA 01845 NEW NAME (same owner) Rohm and Haas Electronic Materials 455 Forest Street Marlborough, MA 01752 Shipley Company, L.L.C., 60 Willow Street, North Andover, MA 01845 Tel: 978/557-1700 Fax. 978/557-1701 Please note that Mr. Joseph Reiser, General Manager, will remain the facility contact and is an authorized representative of the new user. Should you have any questions with regard to the above, please contact me. Sincer Randall Gdy t Manager, Environmental Health & Safety CC; Board of Health, Town Building North Andover, MA 01845 Building Inspector, Town of North Andover, MA 01845 91 SHIPLEY A WOMM AND HAAS COMPANY June 28, 2002 Ms. Joyce A. Bradshaw Town Clerk Town of North Andover 120 Main Street North Andover, MA 01845 Dear Ms- Bradshaw Please be advised that effective July 1, 2002, the assets of the Metalorganics Division of Morton International Inc., located at 60 Willow Street, North Andover, MA 01843 will be sold to Shipley Company, LLC, a Delaware limited liability company. Both Morton International and Shipley Company, LLC are subsidiaries of Rohm and Haas Company, a Delaware Corporation. If there are any licenses/permits under our former name, please update appropriately. Please note that Mr. Joe Reiser, General Manager, will remain the facility contact and authorized representative for Shipley Company, LLC, at 60 Willow Street, N. Andover. Should you have any questions with regard to the above, please contact me. Sincerely, �f ��� Randall oyet EHS Manager cc: Paul Cohen J. Reiser B. McCrellish Board of Health. Town Building, N. Andover, MA 01845 Building Inspector, Town Building, N. Andover, MA 01845 Shipley Company, L.L.C., 60 Willow Street, North Andover, MA 01845 Tel: 978/557-1700 Fax: 978/557-1729 365-r � TOWN OF NORTH ANDOVER PERMIT FOR WIRING _7 This certifies that ......-..z!. i_c.... %. .✓.......... ...... .... ........ . ..... has permission to perform ................ .. ................. wiring in the building of ......... x ........ ............................. at ... / .......... . . ................. . North Andover, Mass. /. /, Fee. Lic. No:'!.,. ............ -.,,o .... . ........................ .... . .................. .... ELECTRICAL INSPECTOR Check # /,LIZ THEC0MM0NWE4LTH0FM4SS'4aff S -m DEPAR�OFPUBL ICS9 FEI Y BOARD OFFIREPMMW0NRFaGUL4T1W527G1? 12.09 Office Use only— Pennit No. Occupancy & Fees Checked PUCATIONFOR PERW TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL IN Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) (C;� I , ow ST a Owner or Tenant U<,Oh,''') f+ Owner's Address Is this permit in conjunction with a building permit: Yes M No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ��. Amps/ . Yolts 0verhead Underground � No. of Meters New Service Amps / volts Ove�� Un �.� Q derground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. ofLi¢htine Outlets .._ No. of Receptacle o. of switch pude No. of Ranges x No. of Disposals Vo. of Dishwashers to. of Dryers lo. of Water Heaters o. Hydro Massage T Ill` or-peowwaft PA esti.•!mimadwGdpioofafsanebtFleO&,+e: JitANC� BOND CJ iVAXCMMki14WcdLS >�Nl� ►tea=GC>�l�t i L C f ✓ S I�oaseNa fn -39ra No. of 00 No. of Gas ' No. ofAit No. of H P Space Area total FIRE ALARMS Tons Dud Total Na ofDeiectim and u6s KW bidatiogDevices RW Na ofSapdina:Dpriew Na Of Se COMOined Ddit* i 36Wdl>rg`Devices i KW LocalMunicipal Connections No. of No of Motors Total E No. orzonft iNAW tae LinaiseNo J � S ZVl���' �� / Btsitl�sTell�lo 7578• o F7 7 ' AttTelNa�-- ER SMURANCEWANER,larna�vatethattl�eLioensedoesnotha►+e$leir t�oeco►a�e sti tr aletp�ava)e�tassagehedb!' se�tsGalealLaws tmysignatiseonthisp eppli VMPAS sreqmtment. ;e check one) Owner ED Agent ED Telephone No i PERMIT FEE 1hll ' i74f,) 1ASg72 %4i\1t f 0 oe S Commonwealth of Massachusetts S S S 3 A Please Enter Decal # Asbestos Notification Form ANF -001 M11?55322 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ± A. Asbestos Abatement Description 1. Facility Location: Rohm & Hass Co. Name of Facility No. Andover MA City/Town State Worksite Location: Laboratory E 5z -F;t s,/,� 60 Willow Street Street Address ` 01845 Zip Code Telephone 2. Building name, #, wing, floor, room. Is the facility occupied? ® Yes ❑ No 3. Asbestos Contractor: Environmental Solutions Inc. 50 Guinan Street Name Address INSTRUCTIONS Waltham 02451 781-8799-3370 1. All sections of City/Town. Zip Code Telephone this form must be AC 00042 Contract Type: ®Written E] Verbal completed in order DOS License # to comply with Dennis Ludwig Project Engineer DEP notification requirements of Facility Contact Person Contact person's title 310 CMR 7.15 4. Scott Pineau AS 50945 and the Division Name of On -Site Supervisor/Foreman DOS Certification # of Occupational S Safety (DOS) 5 N/A small scale associated project work notification Name of Project Monitor DOS Certification # requirements of N/A 453 CMR 6.12 6• Name of Asbestos Analytical Lab _ DOS Certification # 2. Submit Original Form to: Commonwealth of 4-25-02 4-26-02 Massachusetts Asbestos Program 7, Project Start Date End Date PO Box 120087 Boston MA 02112-0087 7:30 AM to 3:30 PM No _ Work hours Mon -Fri. Work hours Sat -Sun. 8. What type of project is this? ❑ Demolition ❑ Renovation ❑ Repair ® Other, please specify: Hood ventilation upgrade 9. Check abatement procedures: ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup ® Other, specify: Safe work practices to core transide lining for ® Full containment pipe conduit. 10. Is the job being conducted: ® Indoors? ❑ Outdoors? T' ..BOARDd OF RTH ROXNIIDG OF HEALTH 5199 Rohm &Haas • 2/02 Asbestos Notification Form •Page 1 of 4 APR 2 2 2002 Commonwealth, of Massachusetts S SS 3-- _ Please Enter Decal # Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) 11. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: pipes or ducts (linear ft) Boiler, breaching, duct, tank surface / coatings lin. ft sq. ft Corrugated or layered paper pipe / insulation lin. ft sq. ft Transite board, wall board lin. ft sq. ft Spray -on fireproofing lin. ft sq. ft Rick Colby / Cloths, woven fabrics lin. ft sq. ft Thermal, solid core pipe insulation lin. ft sq. ft 12. Describe the decontamination system(s) to be used: Double coverall suits will be utiized. 10 other surfaces (square ft) 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): Asbestos waste will be wetted and double bagged in six mil asbestos labelled bags. They will be nInnind in a rincari Inr.kari rnntainar fnr riicnncal to an gnnrrnrar1 achactnc landfill 14. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: Name of DEP official Date of Authorization Name of DOS official Title Waiver # Title Date of Authorization Waiver # 15. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes ® No B. Facility Description Insulating cement lin. ft sq. ft 2. Is the facility owner -occupied residential with 4 units or less? ® Yes ® No Trowel/Sprayer coatings lin. ft sq. ft 3 Facility Owner Name /10 Transite board, wall board lin. ft sq. ft Other, please specify: Zip Code Telephone Rick Colby /10 4' Name of Facility Owner's On -Site Manager lin. ft sq. ft 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): Asbestos waste will be wetted and double bagged in six mil asbestos labelled bags. They will be nInnind in a rincari Inr.kari rnntainar fnr riicnncal to an gnnrrnrar1 achactnc landfill 14. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: Name of DEP official Date of Authorization Name of DOS official Title Waiver # Title Date of Authorization Waiver # 15. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes ® No B. Facility Description 1. Current or prior use of facility: Offices and laboratories 2. Is the facility owner -occupied residential with 4 units or less? ® Yes ® No Rohm & Haas Co. P.O. Box 1150 3 Facility Owner Name Address Philadelphia, PA 19106 215-785-7719 City/Town . Zip Code Telephone Rick Colby 60 Willow Street 4' Name of Facility Owner's On -Site Manager No. Andover 01845 City/Town Zip Code Telephone 5199 Rohm & Haas • 2/02 Asbestos Notification Form • Page 2 of 4 . M Commonwealth of Massachusetts S 5 5 3 2--1- Please Enter Decal # _ Asbestos Notification Form ANF -001 B. Facility Description (cont.) N/A 5' Name of General Contractor Address City/Town Zip Code Telephone Contractor's Worker's Comp. Insurer Policy # Exp. Date 6. What is the size of this facility? 1200 Work Area Square Feet # of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary) to final disposal site: Environmental Solutions Inc. 50 Guinan Street Note: Transfer Name of transporter Address Stations must Waltham, MA 02451 781-899-3370 comply with the Cityfrown Zip Code Telephone Solid Waste Division 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 Waste Management P.O. Box 144 Name of transporter Address Portland, CT 06480 800-272-3867 City/Town Zip Code Telephone 3. Refuse transfer station and owner Address CityfTown Zip Code Telephone 4. Waste Management of NH, Turnkey Landfill Waste Management of NH Final Disposal Site location name Owner's Name 90 Rochester Neck Road Rochester Address CityfTown NH 03839 603-330-0217 _ State Zip Code Telephone D. Certification The undersigned hereby states, under the Joseph E. Duffey y- -0 penalties of perjury, that he/she has read Name uthorized Sig re Ad Date the Commonwealth of Massachusetts president Environme Solutions Note: Contractor regulations for the Removal, Containment must sign this form Positionfritle Inc. for DOS notification or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the 781-899-3370 50 Guinan Street purposes information contained in this notification is Telephone Address true and correct to the best of his/her Waltham, MA 02451 knowledge.and belief. City/Town Zip Code Fee exempt (city, Town, district, municipal housing authority, owner -occupied residential of four units or less?) ® Yes ❑ No 5199 Rohm & Haas • 2/02 Asbestos Notification Form • Page 3 of 4 -7 Date... TAO 11 TOWN OF NORTH ANDOVER PERMIT FOR WIRING .. v .......................................................... This certifies that .......... U..( .... (I. I..,. .,. has permission to perform ............. C ............................................... ..... .... wiring in the building of ......... , . ... -/ .... /. .. r ................................. .. . .. . ......... ... at* ... ...... '.1 ........................... North Andover, M a5s--II �!i ? ...... Lic. NO"�/ ......... ........... EiLE- CA��4Ee��I�;� Check # A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 3V Occupancy and Fee Checked [Rev. 11 /991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: July 1, 2002 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) 60 Willow Street, North Andover, MA Owner or Tenant Rohm & Haas Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. Yes [:] No [] (Check Appropriate Box) Utility Authorization No. Overhead Undgrd No. of Meters Overhead Undgrd No. of Meters � Location and Nature of Proposed Electrical Work: HVAC Controls Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above oIn- No. o Emergency Lighting rnd. rnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons """"""""""'""" KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other Connection No. of Dryers Heating Appliances Key Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER E] (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Viking Controls, Inc. LIC. NO.: 17146A Licensee: Brian G. Rushton Signature LIC. NO.: 17146A (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603-881-4830 Address: 2 Townsend West, Unit 2, Nashua, NH 03063 Alt. Tel. No.: 800-248-4830 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 E] owner's agent. Owner/Agent PERMIT FEE: $ 75.00 Signature Telephone No. Location 6" No. :Z- Date z `� ,. TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '�s •noE< Building/Frame Permit Fee $ swCHus Foundation Permit Fee $ Other Permit Fee / $ TOTAL $ Check # 111-I ) i 5 ; 7 Building Insp or L U) Q W O 0 Z Q F - w O Z 7 a N O O N M L- 0 0 v .o, u m tr N N 0 c O N E L a cts t > C ftf E L CD a i cm C C. U U c� C: O N CL N L 0 .O N O Q. d I Cl) 3 0 3 0 m N O L O Z 4- 0 3 O F- N C .O c O m 75 co as D.' O L O C J J'2ia1j.S1GN, A RANA r rye WORLD GOES FGR Sia 461 South Street, Marlborough, MA 01752 508-481-7551 FAX 508-481-2545 E-Mail:lyka-9@worldnet.att.net September 8, 2002 Mr. Michael McGuire Local Building Inspector TOWN OF NORTH ANDOVER 27 Charles Street North Andover, MA 01845 Mr McGuire Herein please find an application for a sign. A sign with the same dimensions already exists and we are changing the face to reflect the name of the parent company. Colors and sizes are reflected on the proof. Please let us know if all the pertinent information is stated conforming the bylaws and the amount of the permit fee. A check will be dropped off to you in a timely fashion. Thank you for your help. Franco Riello "Independently Owned And Operated" http://www.sign-a-rama.com W W Q z Q F- 0 Z LL Z 0 H z 0 H U_ J Q. CL �I W CL Z U 31 3 9 iii co W tII � J J c CCM O C L m 'C•. 0 m M J m 0 0 Q) O 0- 0 L a N m(D r J Q N O .= d c m U (II = m m O U r a 0 o c O i� LU Q Q) E m c .o a) C U O a) L> R7 — C W O cn � � N U w Q) c C (6 —_ L cn w t" LLJ O ,^. U p k c cn E m cn a) O ^L w ._. c o' C a L 0 N. a) Q O (n o c � m cn w U 31 3 9 iii co W tII � J J c CCM O C L m 'C•. 0 m M J m 0 0 Q) O 0- 0 L a O z cn (U c m iv U cn c (4 0 0. O U C: a) Q 0 a) C6 z cn 0 — 0 W f—' a W U U Q W In F- 0 z J J_ z 0 U J Q. a W H W J Q. 0 Z z a J N m(D r J Q N O .= d c m U (II = m m O U aci 0 o c O LU Q Q) E m c .o co U O a) L> W O cn � � N U w Q) c C (6 —_ L cn (V C w C C c0 V L L m m Q) m U a� cn E m cn a) � in o c' cc w T o cc c "= m L T U Ci T Q U O O O a L 0 0--- (B c. �. a) Q O (n o c C m cn w C m C O � � U a�©1 .in ` C S CII C cL O O r- Q O L O O_ C U N cn O .. O cn O O z o E o a :T— m U O CL CL C O O L U (B N p w U C O `- ..0 c a� =3 m Z cu Q co cn O z cn (U c m iv U cn c (4 0 0. O U C: a) Q 0 a) C6 z cn 0 — 0 W f—' a W U U Q W In F- 0 z J J_ z 0 U J Q. a W H W J Q. 0 Z z a J N Q C m LU Q c co W r � N (6 a� w L 0 C w �f1i„ w am .in cn O o m CL cn m 0 U ..0 Q .. _win 0_ CD to Cn N C _ 4) O O Ql a_2Ucn00 O z cn (U c m iv U cn c (4 0 0. O U C: a) Q 0 a) C6 z cn 0 — 0 W f—' a W U U Q W In F- 0 z J J_ z 0 U J Q. a W H W J Q. 0 Z z a J Q LU Q J co W H Q � N SIGN PERMIT WORKSHEET Property Owner. �/� !,�/�P y K�o /J !tel Y- 11-4 x S Business Name G�O *l V_241,4d4 S Property Owner Address 6 O W- I l l© C'U S Sign Location Address S a- V"'L'R' Zoning District , Allowed Area Proposed Area `� 7 Allowed Height ® Proposed Height i Allowed Setback �� Proposed Setback CJ Map 5 o Lot � Estimated Cost $ 5 �� Fee $ Permit Application Received 9— 1 Inspector ��..,,"SHIPLEY El zo� A ROHM ANO NAA COMPANY HAAS D SO 2T NORTH ANDOVER FACILITY 18' ❑ 0 9 Slim $'w! X 8"d x 18"h ❑ ❑ alun num 9/8"thictt ❑ ❑ lVd x 108"w it 59.75"h ❑ ❑ ❑ Date! .G. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that 'A /I -(!L'L....... . has permission to perform ..... F ... ......................... . plumbing in the buildings of . 1112- lll....................... at .. 1/4. < ....~.......:-.. , fNorth Andover, Mass. 4L I Fee..>) .... Lic. No.. :L�.? .... ....... ....-!�"-0�,;' �..... . X PLUMBING INSPECTOR Check # 1«,-i - b/ Z 72609 „V J�e MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO PCO PLUMBING <, (Print or Type)rmmnzm� nn l I V l)6 11 a , Mass. Date / d 4 7 19 Permit # ? s Building Location 6 o G1, LGdGj/ S-7' Owner's Name G7 D �i pir f- //moi--' Type of Occupancy�%�%r .New ❑ Renovation ❑ Replacement Dg� Plans Submitted: Yes ❑ No ❑ IN FIXTURES IRc. Installing Company Name Griffin & Merrow, Check one: Certificate Address 7 Walnut St. M Corporation 4S6C Peabody, MA 01960 E] Partnership Business Telepho -531-0150 ❑ Firm/Co. Name of Licensed Plumber R. Loring Merrow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes l No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in a e ap ' tion are true and accurate to the best of my knowledge and that all plumbing work and installations performed u r the per fo is application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code a ape La f the Laws. By Signature of cen d r Title Plumbing Inspector Type of License: Master Journeyman E] City/Town 9322 APPFiONED OF IC ONLY) License Number wag IRc. Installing Company Name Griffin & Merrow, Check one: Certificate Address 7 Walnut St. M Corporation 4S6C Peabody, MA 01960 E] Partnership Business Telepho -531-0150 ❑ Firm/Co. Name of Licensed Plumber R. Loring Merrow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes l No ❑ If you have checked res, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in a e ap ' tion are true and accurate to the best of my knowledge and that all plumbing work and installations performed u r the per fo is application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code a ape La f the Laws. By Signature of cen d r Title Plumbing Inspector Type of License: Master Journeyman E] City/Town 9322 APPFiONED OF IC ONLY) License Number N 2 O N U W IL N Z N N W O ccIL N V Y N LL r O Z ( m j J O O N O f. F LL d Q O tu 0. ccm U. O LL O m d LLI LL Q Z J O U. O ~ z = J 7 m O C OJ ULU H 3 !4tu H 'a'a LH C" cc W a 4-3 4-J 0 H (b n <cCL W f, Q t7 W i C aC W 0. F- V N Z c7 = m J N V Y N LL r Date./ ate . .- .G..7...... o= ` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. `. ! .f fad ..l Xd (-t... //.; . has permission for gas /installation .. � .1f .................... in the buildings of ................................ at North,Andover, Mass. Fee.Lic. No. g.7,�.L... ..... .... ..... GAS INSPECTOR 11 Check #/,i - /( )e. � 5899 Q MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /tY�OdV?i, Mass. Cate �° 719 Peermft * S `�' c( Building Location 6 d L44 `10 kil 1517— Owner's Name G Type of Occupancy /R10 -el New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ Installing Company Name Griffin & Merrow, Inc. Check one: Certificate Address 7 Wq 1 n„ r q t_ a Corporation 486C Peabody, 11A.01960 ❑ Partnership Business Telephon 3W531-0150 ❑ Firm/Co. _ Name of Licensed Plumber or Gas Fitter R. Loring Merrow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked Yes, please indicate the type coverage -by checking the appropriate box. A liability insurance policy 29 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee sloes not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above appli o e and accurate to the best of my knowledge and that all plumbing work and installations performed under the perm ed for s tion will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of th er S. By TIJoumeyman of License: Tale Gas Inspector Plumberuminature cense um er or ash Fitter Master License Number 9322 City/Town III ��■����■������� ��■�■���■moi ME moommommommonomms IKM SOMEONE Installing Company Name Griffin & Merrow, Inc. Check one: Certificate Address 7 Wq 1 n„ r q t_ a Corporation 486C Peabody, 11A.01960 ❑ Partnership Business Telephon 3W531-0150 ❑ Firm/Co. _ Name of Licensed Plumber or Gas Fitter R. Loring Merrow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked Yes, please indicate the type coverage -by checking the appropriate box. A liability insurance policy 29 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee sloes not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above appli o e and accurate to the best of my knowledge and that all plumbing work and installations performed under the perm ed for s tion will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of th er S. By TIJoumeyman of License: Tale Gas Inspector Plumberuminature cense um er or ash Fitter Master License Number 9322 City/Town W W LL O O Z J i W H D `J Date, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S SA US This certifies that .. has permission to perform .-.7........ plumbing in the buildings of ............ at ..... ....... .......... North Andover, Mass. Z�'- d \16 Fee......... Lic. No .......... ............. ................ Check # 115z� 7976 PLUMBING INSPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ov� , Massachusetts Date 0 a 20 09 Permit# Permit Feed .. Building Location �,o ��t � � Oc,�.3 St. Owner's Name New ❑ Renovation,Zr Replacement ❑ FIXTURE Type of Occupancy Cgrnm� t C ►A 1 Plans Submitted Ye -.e No ❑ Installing Company Name NORTH SHORE MECHANICAL CONTRACTORS Address 6 GARDEN ST., SUITE TWO DANVERS, MA 01923 Business Telephone (978) 774-9800 Name of Licensed Plumber or Gas Fitter Joseph M. Whitney INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142 Yes ❑X No ❑ If you have checked yes, please indicate the type of covering by checking the appropriate box A liability insurance policy ❑X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check One Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above my knowledge and that all plumbing work and installations performed under the permit issu pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General By Type of License / Title ❑ Plumber Signature of L ❑ Gasfitter City/Town ® Master License N APPROVED (OFFICE USE ONLY) ® Journeyman License N t ication are true and accurate to the best of ,,this application will be in compliance with all Inspection Date Required or Gas Fitter 9664 r Check One Certificate ® Corporation #1441 ❑ Partnership ❑ Firm/Co INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142 Yes ❑X No ❑ If you have checked yes, please indicate the type of covering by checking the appropriate box A liability insurance policy ❑X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check One Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above my knowledge and that all plumbing work and installations performed under the permit issu pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General By Type of License / Title ❑ Plumber Signature of L ❑ Gasfitter City/Town ® Master License N APPROVED (OFFICE USE ONLY) ® Journeyman License N t ication are true and accurate to the best of ,,this application will be in compliance with all Inspection Date Required or Gas Fitter 9664 r Date .. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION _ s This certifies that ..�. �.............. �� has permission for gas installation . �� //�``�'P.-'�... in the buildings of .... ... `.'�.. �.T'`..S................ . at /�! a ... ��° ' �' J r , North Andover, Mass. Fee �! �j '.: Lic. No..(� �! \ .�/"ems.......... GAS INSPECTOR Check # 11538-' 6652 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ( rintorType) assachusetts Date t7— 20 C9 Permit # ENE Permit Fee Building Location 60 ��� 11 S� Owner's Name R Axn HAAS Type of Occupancy CaM11nffC(0<1 New ❑ Renovations Replacement ❑ Plans Submitted: Yes K No ❑ Installing Company Name NORTH SHORE MECHANICAL CONTRACTORS Check One Certificate Address MM STREET �/D�p(QAO t -(V ® Corporation #1441 (2-,A)3 J�-ZS =UHtM=MAS ❑ Partnership Business Telephone (978) 887-3093 ❑ Firm/Co Name of Licensed Plumber or Gas Fitter Joseph M. Whitney INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes [91 No F-1 If you have checked yg�s, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my siqnature on this permit application waives this requirement Signature of Owner or Owner's Agent Check One: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. Type of License By ❑ Plumber Title ❑ Gasfitter ® Master City/Town ® Journeyman APPROVED (OFFICE USE ONLY) Signature of Xi jensed FFumber or Gas Fitter License Nqrraber 9664 License Nffnber 18587 Inspection Date Required a COMMONWEALTH OF MASSACHUSETTS E PLUMBERS AND LUMBING CORP REGISTERED AS ISSUES THIS LICENSE TO JOSEPH M WHITNEY NORTH SHORE MECHANICAL CONT Ad :m 6 GARDEN ST =N. STE 2 DANVERS MA 01923-1 1441 05/01/10 43069 COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO I JOSEPH M WHITNEY 26 GREENLEAF DR ol DANVERS MA 01923-1 9664 05/01/10 4306944 • • COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS t LICENSED AS A JOURNEYMAN PLU IF, ISSUES THIS LICENSE TO JOSEPH M WHITNEY ti 26 GREENLEAF DR DANVERS MA 01923-15 I 18587 05/01/10 43069 ACORD CERTIFICATE OF LIABILITY INSURANCE OP.ID S DATE(MMIDDIYYYY). .: NORTHIO 08/11/08 - PRODUCER THIS CERTIFICATE.IS ISSUED AS A MATTER OF INFORMATION Thomas Gregory Associates Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,, EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 AUTHORIZED RE,SENTATI Phone: 781-914-1000 Fax:781-246-2601 INSURERS AFF ORDING::COVERAGE : NAIC#- : . -INSURED----- --- ---- ---------_—.------------------ _._. -- ------._._.._,..-------- — INSURERA:--"Nailayevil'le wordect•s Ina. 26182—`--" INSURER B: A INSURER C: North Shore Mechanical Contrac 6 Garden St. Suite Two Danvers MA 01923 INSURER D: INSURER E: 07/Ol/09 GUVEKAUES 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 PtRTAIN, 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 NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD T POLICY EXPIRATION DATE MMIDDIYY LIMITS AUTHORIZED RE,SENTATI GENERAL LIABILITY EACH OCCURRENCE $1,000,600 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE rX] OCCUR MPA2M32 71 07/01/08 07/Ol/09 PREMISES Ea occurence $ 3 0 0 0 0 0 MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY , $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000 POLICY X PROO-CT F LOC A AUTOMOBILE X LIABILITY ANY AUTO BA2M327.1 07/01/08 07/01/09 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) X X HIREDAUTOS NON -OWNED AUTOS BODILY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY -AUTO ONLY - EA ACCIDENT $ ANY AUTO • OTHER THAN EA ACC $ AUTO ONLY: AGG $ ---EXCESSIUMBRELCALIABILITY A X OCCUR 7 CLAIMSMADE BE2M3271 07/01/08 07/0.1/09 EACH OCCURRENCE _$7— 7A AGGREGATE $7,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS I I ER E.L. EACH ACCIDENT $ ANY PROPRIE70RIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- EA EMPLOYEE $ EL. DISEASE- POLICY LIMIT $ OTHER APPLIES TO ALL 10 DAY NOTICE OF POLICIES CANCELLATION FOR NON PAY DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS �•��.�u��sar�:�•����a: a��, rM�uwrul, ^I Wr%w 6.7 tLUU7rU0I _ ` d v ©ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Evidence of Insurace IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE,SENTATI ^I Wr%w 6.7 tLUU7rU0I _ ` d v ©ACORD CORPORATION 1988 Date4- - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...... .............................. has permission to perform plumbing in the buildings of ..................... at. ... .... . .......... North Andover, Mass. Fee./..Lie.......... Check # P L U M 8 1 N G64�/'P-E'C TO R 7946 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location /� G+/�� eve Date Owners Name �� f�c llc'i� Permit Type of Occupancy Amount 7 New Renovation rl Replacement ' ED Plans Submitted Yes ❑ ❑ No Ti'Ti'TT TD r,c� kr WIL ur Lype) 1- 1 Installing. Company Name Ayrp� ���•��/� Check one: Certificate .L rp. hof; Address X70 �y''��9%. �e Gni%.�,p�ey �"�� o� �7 ❑ Partner. tsusiness Telephone - ---------- n Firm/Co. Name of Licensed Plumber: —7;x- /✓, %4 Insurance Coveraze: Indicate the type of insurance coverage by checking the appropriate box: i Liability insurance policy Other type of indemnity Bond a .moo Insurance Waiver. I, the undersigned, have been made aware that the licensee three insurance of this application does not have any one of the above Signature Owner ❑ F1Agent 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 Massachus t State Pl o Code and Chapter 142 ��b P of the General Laws. By: City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License Lcense NUMDer Master ❑ Journeyman r -' J/ 3678 Date .� .... — q -;L- ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 This certifies that ............... ......................... has permission to perform ............................................................................... wiring in the building of ...... rv� ........................ at Z .......... .................... . North Andover, Mass. it Fee. . ...... ..... Lic. No 144 ... 7k .............. ..........L ....................................... ELECTRICAL INsPEcr0R Check # TIMCYI WOMV ' LTHOFM4SSAaffMM ogee use only DLPARTM1NT0FPUBMC&4FM Permit No. j G BOARD OFFIREPFEMWONA%VL4HO1SS27C�R 1ZlAD Occupancy & Fees Checked V..APPLICATIONFOR PERW TO PEUORMaECMCAL WORK ALL WORK TO BE PERFORMED 1N ACCORDANCE WITH THE MASSACHussTs ELECTRICAL CODE, Si7 CNII2 12 OO (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat445' Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below_ Location (Street 1 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes Q No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps/ vvolts lOverhead --- . � Un dergtexlnd � No, of Meters Number of Feeders and Ampacity — -- Location and Nature ofProposed Electrical Work No. of Lighting Outlets I No. of Hot Tubs No. of Receptacle Outlets ) No. of Switch Outlets (/ � No. of Ranges `/7 No. of Disposals Vo. of Dishwashers Co. of Dryers Jo. of Water Heaters KW oHydro Massage Tubs tanoeCo Asarartbtheratp:arra,lsatbl eatxnentliabftkMr =PCFCyircLr Cm e%* nbedm&poafolsametotlroff s YEg JR t1 E BOM, No. No. of Air Conti. Total FIRE ALARMS No. ofZonft Tans No. of Heat TOW Tonal No. ofDetectionand To6s KW brills iogpevices Space Area Heating KW Na ofS000ft:Derices. - Na of SWConbined iiesting.Devices i KVIr DetectiUmSoWdidg' Devices Local Municipal Other Connections �. Vo. of No. of ,ignsBailasis Jo. orMotors Total HP %LTJ )GS�-' 'ti �S . yell GMaaiLaw . ��scouergeaissr>bs�n�tetr;tcti� YES �} `.. J J NO 0 � >a�;�waaE.s f dundwTieftakits FW, NAME �' L T7o('`�'Ai El d7 _eJr Gl- . -� L�oaseNa � �� 3 — -- � 'L Lit>�eNo Qt'SMJRAMMWANFR;Iamaw wdmtdrlket>sedmivtlm+edxmnnoeco► mWcrgssr mec}rig� AItTe1Na tmy cnftpmnteppficebmw�tlasra4m,anett ��edbYM dta Ga�aalLaws ce check one) Owner ED Agent Telephone No. PERMIT FEE $ The Commonwealth of Massachusetts FOR OFFICE USE.° L Permit No. Department of Public Safety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) shy APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL (INFORMATION)) Date City or Town of />0/?%t>• H1idyl�/y To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location (Stree'_ and Number) y 0 "Alow ow Rea -r Map: 110 Lo': I Owner or Tenant F xrh.'koihaaf� � Zone: _r_11 Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service 30M Amps/wo Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Yes POINo ❑ (Check Appropriate Box) Utility Authorization No. SOI -36-7 Overhead ❑ Underground R/. No. of Meters_ Overhead ❑ Underground ❑ No. of Meters No. of Lighting Outlets No. of Hot Tubs — No. of Transformers Total KVA • No. of Lighting Fixtures 260 Swimming Pool Above grnd. ❑ Ir grnd. ❑ Generators KVA No. of Receptacle Outlets S No. of Oil Burners — No. of Emerg. Lighting Battery Units No. of Switch Outlets ' fo No. of Gas Burners — FIRE ALARMS No. of Zones —� No. of Detection and t1;s Initiating Devices g No. of Sounding Devices No. of Self -Contained Detection/Sounding Devices No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Total Total Heat Pumps --- Tons KW i No. of Dishwashers _ Space/Area Heating KW No. of Dryers — Heating Devices (,4J KW No. of Water Heaters KW No. of Signs _ No. of Ballasts �/ Local ❑ Muncipal Connection L►� Other No. of Hydro Massage Tubs — No. of Motors Total HP — Low Voltage Wiring a—� OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) LI • kl AA LL (Expiration Date) Estimated Value of Electrical Wor $ Work to Start Inspection D to Requested: Rough t%t (A Final Signed under the penalties of perjury: _ FIRM N �_ —14 LIC. N0. 97/ Licensee Signature IC NO. Address Bus. Tel. No. All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waivesthi equirement. Owner ❑ Agent ❑ (Please check one) Telephone No. PERMIT FEE $ l/ v (Signature of Owner or Agent) INSPECTION RECORD Date I Notes — Remarks /a Y 3 .." Inspector W 1 471 Date.. J Ok--- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ! g.f..lI. CCS QNu C .. 77.64. C. has permission to perform ..... .... ... (S..o........... o--...... ........ wiring in the building of ......(v...t. vitt 11..................... cu "! ............. at . �../..}.(r!.!.. �%.. ..................................................... North Andover, Mass 1� 't l... Lic. No.?¢.� t� Fee. .. ... .. .............. .......I ELECTRICAL INSPECTOR 3s 7 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer — :3 R9..rlu,t (Print or Type) NORTH ANDOVER,, Maas. Date _I0 Building Permit Owner's Name New 0 Renovation O Replacement Q Plans Submitted: Yes 21 -/No. ❑ FIXTURE$ -. k one: Certificate Installing Company Name T4' "r 6 orp, A v 7 -C Address V 3-0 3,© O Partnership o O Firm/Co. Business Telephone elirk - 32---o-> e Name of licensed Plumber INSURANCE COVERAGE: check one 1 have a current liability Insurance policy or No substantial equivalent Yea 11 No 0 If you have checked y". please Icate the type coverage by checking the appropriate box A liability Insurance policy . Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General LAws, and that my signature on this permit application waives this requirement. Check one: §Fnaturs of Owner or Ormat s Aaent Owner D Agent p 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 knowfedge and that all plumbing work and Installations performed under thepem►It Issued for this application wilt be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 1�Z of al Laws. By - - J nafkxe of licensed PIUW13ii— This Gty/Town License Number ?d' Type of Plumbing license: Master ArTIF"YED (OFFICE USE ONLY) Journeyman ❑ 0 log 11, ~ V M » M r X M s �.It r M 16 ` t Y 0 r � M � � � Ie A p � M Js on � � � 16 U y< �a 6 a<~he t s~ M� 16 J iticlo«oo�ts' Z s O~ iIL so iis°c.�i��- 0 V � a� auk—�aMT. SAe[MGHT IGT FLOOR 13 PD 1 3 INDFLOOR 11110 FLOOR 4TH FLOOR •TN FLOOR ITH FLOOR. ITN FLOOR aTH FLOOR - k one: Certificate Installing Company Name T4' "r 6 orp, A v 7 -C Address V 3-0 3,© O Partnership o O Firm/Co. Business Telephone elirk - 32---o-> e Name of licensed Plumber INSURANCE COVERAGE: check one 1 have a current liability Insurance policy or No substantial equivalent Yea 11 No 0 If you have checked y". please Icate the type coverage by checking the appropriate box A liability Insurance policy . Other type of Indemnity O Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General LAws, and that my signature on this permit application waives this requirement. Check one: §Fnaturs of Owner or Ormat s Aaent Owner D Agent p 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 knowfedge and that all plumbing work and Installations performed under thepem►It Issued for this application wilt be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 1�Z of al Laws. By - - J nafkxe of licensed PIUW13ii— This Gty/Town License Number ?d' Type of Plumbing license: Master ArTIF"YED (OFFICE USE ONLY) Journeyman ❑ Ir 40 Date.... � / . '�V.) `. ,SSACMU5Et This certifies that r . ........ has permission to perform .... r:..... : .!.: // ...... !. !.,._.�. . plumbing in the buildings of ...... !....... !. J.. , .. + .: ( ' ....... r I f at.' :........ . ........... ............ , North Andover, Mass. J Fee:.. - Lic. No..:. . . .............................. PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File tia TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMU5Et This certifies that r . ........ has permission to perform .... r:..... : .!.: // ...... !. !.,._.�. . plumbing in the buildings of ...... !....... !. J.. , .. + .: ( ' ....... r I f at.' :........ . ........... ............ , North Andover, Mass. J Fee:.. - Lic. No..:. . . .............................. PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Town of North Andover Building Department 27 CHARLES ST 978-688-9545 APPLICANT : Rohm & Haas 61 Willow.St North Andover, MA 01845 Project: Batten Bros. Sign Advertising For Rohm & Haas V3 Main St Wakefield ,MA. 01880 DATE: December 1, 1999" Title of Plans and Documents: as above Please be advised that after review of your Building Permit Application and Plans that your Application is DENIED for the following reasons: Zoning Use riot allowed in District Not in conformance with Phased Development Violation of Height Limitations Sign exceeds requirements X Violation of Setback Front ? Side Rear Insufficient Lot Area Insufficient Parking Violation of Building Coverage Insufficient Open Space Use requires permits prior to Building Permit Sign requires permits prior to Building Permit Form U not complete by other departments Not in conformance with Growth By =Law Other Remedy for the above is checked below Dimensional Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Other Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information reauires more clarification 4 Infnrmntinn is inr,nmort S All of tho ns, Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4- Information is incnrrent s All of tho h,,,o Health Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure Construction Plans 116 Affidavit Mechanical Plans and or details Plans Stamped by proper discipline Electrical Plans and or details Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities x 1 Site Plan Water Supply Sewage Disposal Waste Dis osal Other see reverse ADA and or ABBA requirements Administration The documentation submitted has the following inadequacies: 1. Information Is not provided. 2. Requires additional information. 3. Information requires more clarification. 4- Information is incnrrent s All of tho h,,,o The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information or other subsequent! changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit applicatio jform and begin the permitting process. ,Building Department Official Signature Application Received 11/16/99 If faxed: _ Denial Sent Referral recommended:—. Application Denied 12/1/99 Fire Health Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information or other subsequent! changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit applicatio jform and begin the permitting process. ,Building Department Official Signature Application Received 11/16/99 If faxed: _ Denial Sent Referral recommended:—. Application Denied 12/1/99 Fire Health Police Zoning Board Conservation Department of Public Works Planning Historical Commission Other x BUILDING DEPT Gc: vvllllam Jcoit 0 t Revised 9197 jm Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the building permit for the property indicated on the reverse side: ��VV�C ii{s ..Yi,k@��bin�for,��lr�lal_�-z a' i 1 ka �r�3rf4.'fa�� 1•. ro�'a`Wy�x�•��i�Fi,� " i� 2YS�3 +rn 3�+f�1f,J,p� Cll�<i �'R a"iY Sf l�: +' F.ti li f'.�Yf �S �1`.J� f.6�,;�f..4R�F�F t.Xri.1K �:k�k�417 „a,+s�fr��%���`�.,�Y`,1'f�� i'r 1. �X �$,� �t{t •���1�53� l��l�M:,��}�T l�K �.15�3 j�y`r�� � �`..:lfY 4 3�xlS. No certified site plan with measurements showing location of sign, unable to determine if sign meets requirements for setbacks from property lines. SIGN PERMIT WORKSHEET Property Owner Business Name`�- Property Owner Address (/t/ / �/ © vtJ Sign Location Address S ` Zoning District Allowed Area l d O Proposed Area X/, e-' Allowed Height O2 d Proposed Height Allowed Setback T Proposed Setback Nif Map / Lot -� Estimated Cost $ Fee $ =s . Permit Application Received Permit Approved Denied Inspector A LU 0 z Q z LL O zz 7 O H z O U_ J IL CL Q H w a. z' 0 Cl) M O z ^ 0 U C C a) O Q 0 U C m O) Q 0 a) E m z U Q) 0 LU F- a. w U U Q w m H O z J J_ z O 1- U_ J a. (L LU F— LU J CL O U z Q Lu h� _ Z ^� D L.L LL 0 / LLJ rl. � Q N En C U -0 c6 m c T C O U U C ,a (6 N O C U) L �C a) C .— O O L Q) 4« (n N L (n O CB E Q) C N L 0 'O C O T D T O L> L -0 C c4 -O v O cn C N E a) v E cu EL O U N — (n C _ cu E N N C C (� V C (n E cn Q O .w+ r.+ Q C E C O) C> O= 0 cz a >, L m C L N O of +' — ,�- Usz 0\_ o n U L cn O' O O 0 0 0-0— E 0.ma� 0 L m a) Q 0-2 E 'O E N o- M ca O C 0) C =E` % °'°'c'�U _� a) - M N c Cn z c � j E 0 La7u- -O (U Q.0 = O a) U) M Q U V cn co n O .. N O ,O E Q (n E Z -0 a 8E 0 0 Q4= m U Q O 0- a) Q C 0 Cr- U 4- O m C m r+ ((f In U C 0 N O L C m C O L a) E z cam 0-0co �5 CO = O z ^ 0 U C C a) O Q 0 U C m O) Q 0 a) E m z U Q) 0 LU F- a. w U U Q w m H O z J J_ z O 1- U_ J a. (L LU F— LU J CL O U z Q Lu h� _ Z ^� D L.L LL 0 / LLJ rl. � Q N C c C U) m Q) 4« CB L 0 'O C O) C C N E N -0 V C .w+ r.+ Q `�- O n a >, ,�- Usz E o o n cn L a) 0 L m = o- »� O z ^ 0 U C C a) O Q 0 U C m O) Q 0 a) E m z U Q) 0 LU F- a. w U U Q w m H O z J J_ z O 1- U_ J a. (L LU F— LU J CL O U z Q Lu h� _ Z ^� D L.L LL 0 / LLJ rl. � Q '4 • Sim -[ �''Z- %Mc. y.Y � a�tv �/I � psi J/� ,�� } 1••• .. i_ �y •' xe WHOW S yTM r / Y A riz, 1.5 fl m z 0 m z z 0 z i N n fl m ti 6 A A CREVISION NAM DATE 4000uo i rg :c < s �= C, - SHEET10F1 - - - �gy88A 0 v 3 N9 is SCALE-NOTED9 COMPANION FILM - - - - - - mS.,ROHMHAAS-FAGES-Mq.5GV €� gwn Ul I ' � 5'-0' FAGS 1'-0�^ OAS 4'-flg' FRAME a. rj O Z 4t r 4. m O o o> I I GQ o ��07 � I �Lr4.I I 1 II (CD) i N II I— ---7 II II 00 0 II III ��I �I II �D rni �i 2.1 �2'-Ij- L.-4. V-W 2'_2j.-1 r2. aj:TT' 7m 4'-'f$' TUBE 5'-0' FACE P>Zu' i i�-g -nnA Ox A ���� Drn�'r�i c�r�rQODrX zrn rn0 aDA�i� DS ricFii�� SreA° QN D ➢°0 �jO -(rnomt+ �rn m(p rr O lf� NM =H-4 W� 0 zDD30 rn� p Z �m 3 °O A ° 0 ? �O REVISION NAM DATE COMPANMMM ROHMHAA5-FAGE5-MQ - _ - •$ g T G404i9.DH6 99 0� N r S I�JA1cz��3 1T X xS ZI x —c � WNL m [fi-.. r c�-I, I x �� rn 7Z-�j D�1 A (3n rn A 0 s�A r r � m �O REVISION NAM DATE COMPANMMM ROHMHAA5-FAGE5-MQ - _ - •$ g T G404i9.DH6 `� '�� ,, ,, `^-�'� - �� ��R�o'�'�Nr1� � S'�,nd�� rv+anry� J I F el— Date ... , ............ r N2 Z - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ..............................................r ......................... has permission to perform ................................. .... ...... ... wiring in the building of ......... ....... . North Andover, Mass. ............... .. ........................ Fee/ ..... Lic. No!'kR .. ...... ...... ................. .......... . . ..... .. ELECTRICAL INSPECTOR 02/23/99 1o:36 140.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C The Commonwealth of Massachusetts FOR OFFICE USE ONLY TJ Permit No. C;),V, 0, Department of Public Safety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) hV APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work will be performed in accordance with the Massachusetts General Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3-)1° \ VA City or Town of � a 0146 ory4 -(t r To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below: Location (Stree'. and Number) fob W A\0 t..1 Map: L&..: Owner or Tenant m 06MJd4 "S"V-Lr kc.c,��a ".A Zone: Owner's Address 100 Nam, RN,1u-%,Se i\(,.-LkA.- '-OkYAL 6.icc, Go -r1\ `p fo to 0 6 Is this permit in conjunction with a building permit? Purpose of Building existing Service — Amps / New Service Amps / Number of Feeders and Ampacity Volts Yes El No® Utility Authorization No. Overhead ❑ Underground ❑ Volts Overhead ❑ Underground ❑ (Check Appropriate Box) No. of Meters No. of Meters Location and Nature of Proposed Electrical Work � ",.iX b _ �`.o��ry AL3 ui u•�n �r 'f h1 t; TCM c.,.A 1, DL 1�..E'�-r 3 F No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above grnd. ❑ In-grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emerg. Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection'and Initiating Devices No. of Sounding Devices No. of Self -Contained Detection/Sounding Devices No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Total Total Heat Pumps Tons KW No. of Dishwashers .Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No. of Signs No. of Ballasts Local ElMuncipal Connection El Other No. of Hydro Massage Tubs No. of Motors Total HP Low Voltage Wiring OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts Genneppal Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES Lel NO ElI have submitted valid proof of same to this ES office. YM NO El If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 2 BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ 1 , Rq 0 Work to Start Signed under the penalties of perjury: FIRM NAME ELECTRICAL DYNX CS. INC. InspectionADate Requested: Rough Final Licensee GARY R.LETOURNEAU Signature ---kL Address 72B Concord Street, North Read' g, 01864 (Expiration Date) LIC. NO. A13881 LIC NO. A13881 Bus. Tel. No. 978-664-1050 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner ❑ Agent ❑ (Please check one) Telephone No. PFRMTT FFF (� INSPECTION RECORD Date I Notes — Remarks I Inspector 0 aF NaRTi{ Zoning Bylaw Denial 4 Town Of North Andover Building Department �q$ qno 27 Charles St. North Andover, MA. 01845 sa`"0 Phone 978488-9545 Fax 978-688-9542 Street:. Map/Lot. I C/R b Request: /© X 73/y'' Date: .;;?- _ G _ p / Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zonina 2emedy for the above is checked below. Item # Special Permits Planning Board Item # Site Plan Review Special Permit Access other than Frontage Special Permit congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Variance Setback Variance Parking Variance Lot Area Variance Variance for Si n Special Permits Zoning Board Special Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Special Permit for Sign Special Permit preexisting nonconformina The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. / O ilding Department Official Signature Appli tion Received Application Denied Denial Sent: If Faxed Phone Number/Date: item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting 2 Frontage Complies 3 Lot Area Complies 3 Preexisting frontage 4 Insufficient Information 4 Insufficient Information B Use A 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback /,l H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient Building Coverage 6 Preexistingsetbacks �) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information 2 In Watershed j Sign 3 Lot prior to 10/24/94 1 Sign not allowed as 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pr1 ,-existing Parkin 2emedy for the above is checked below. Item # Special Permits Planning Board Item # Site Plan Review Special Permit Access other than Frontage Special Permit congregate Housing Special Permit Continuing Care Retirement Special Permit Independent Elderly Housing Special Permit Large Estate Condo Special Permit Planned Development District Special Permit Planned Residential Special Permit R-6 Density Special Permit Watershed Special Permit Variance Setback Variance Parking Variance Lot Area Variance Variance for Si n Special Permits Zoning Board Special Permit Non -Conforming Use ZBA Earth Removal Special Permit ZBA Special Permit Use not Listed but Similar Special Permit for Sign Special Permit preexisting nonconformina The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and begin the permitting process. / O ilding Department Official Signature Appli tion Received Application Denied Denial Sent: If Faxed Phone Number/Date: Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the application/ permit for the property indicated on the reverse side: Referred To: Fire �Zoniiln�c Police Planni Other Bul nt of Public Works Commission 0:Z w 0 O < � J h � z 0 al z O U) m t` 05 .o 4D N d CL 0 CL w 0 N N m c� c E :3 s= _ '� ' — (a c E Z �w 0 c E S `C r4 0 w L mem ® .c c.E m css cv -o cts -c � � m coa N O > s] t6 0 4 z3 ' all .0 r -L 3 L v, C D L of is to ou C C (D CL O. 0 G Lm G Ru aci. t .. to -0 7a O .L tl! 0 O EQ���> � ii C) g O- CL 'o E 0� M(D Ea.,,cmc�L as sQasQ 0S 11 Z U -a Q y O. m V `w E O c O � a O C �s � :3 tm Z w .0 CL .2 w 'an ........... c rn .y t31 m s ID 7 � � � = c _' 3 ¢xCDo S `C r4 0 w L mem ® .c c.E m css cv -o cts -c � � m coa N O > s] t6 0 4 z3 ' all .0 r -L 3 L v, C D L of is to ou C C (D CL O. 0 G Lm G Ru aci. t .. to -0 7a O .L tl! 0 O EQ���> � ii C) g O- CL 'o E 0� M(D Ea.,,cmc�L as sQasQ 0S 11 Z U -a Q y O. m V `w E O c O � a O C �s � :3 tm Z w .0 CL .2 w 'an ........... c rn .y t31 s ID IDo c CL � � Q U O � cx CD N •� c _ Q 0 - 41 p Ir IrCL CL U0)0 r= C t3] 0 w r a w U d W m H z J J 0 4 L% J w LLI J G LU V LL w a Q 0 K L L c L u spa sp n TO"d `dOb=60 TO-VZ-4z)O 's 59J5 2011 H I P LEY 77.75�� a A ROHM AND HAAS COMPANY 60 WILLOW STREET 20 96, ❑ Skirts 8'w 21 8"d it 113"lh ❑ ❑ 12"d x 10899w u 59.75""h ❑ ❑ ❑ In rim Film Y T1 � r _ Location � �Q zz/f�'/�%s�.�!✓� No. G5 D Date t M TOWN OF NORTH ANDOVER F , Certificate of Occupancy $ t Dyy Building/Frame Permit Fee $ O4' O ACHUse Foundation Permit Fee $ ss�cMu Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ / q;o a J /�� / 7 � Building Inspector Div. Public Works / f Location e-,' 61, No. U Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ }° Building/Frame Permit Fee $ Foundation Permit Fee $ s�cHust Other Permit Fee $ % Sewer Connection Fee $ S� Water Connection Fee $ --�' 1 c� TOTAL $ B i g Insp br t 6910 �� iv. Public Works z 0 z W IL 0 m IL p N V th mm O O FF W W W W N > j p 0 0 a J, F LL 4 0 - N m W W N 6 d N b� \0 � � a J U W W_ 1— FF- J 2: f - SU O O U U I I f„ 1 1 W � O I N � A 1 O ` � ' f � � < o O I I � I W z O � O o t I i O W m O 0 {L 6 .y 00 0O IL 0i WW Zu <0: Na o= o� Q�z .J ONLL. J � f. IL?0 Ooa N Z=N °mu WOg �Nw Z �QN_ UN= XWF WJW 300 u f'X� jWW �ZEL� Z< 0Nu u W W Z NJW N NQF0 J� } u Z n a u O i ` J � ��IIIII IIII �IIIIIII I I IIII III I I f- TI ITI �I $ z z za m LL- 2S ��, Wa oO I I I roI ' � ' 'TIT �` Z � vW~i ZZ�X Q Z Uw; w � o x y v > Z m Q d o v.>>. s O th p W F= Z a N Z oe O a w p w W W /- f 3 Z~ p Q W V Q x Ow V �? p ¢ ¢orc Z ZZcO O1 O¢G0 U> do Sao>a J ¢>�OaO J .^. d°Cw~oe�~�n_� o o U= o N p d x n o D w i V w 2 V a ¢ N a m '- > Y Z N __ f ti d S ¢za a OC � (� p W Z 1—fT l I 1 1 1 1 Z 1 1 0 —' u �o J t F W c7 oFzwwO 0 0 a xw �Zw _Z vi 0' v o r� YO m0 " O F 3 0zo i�gazaa -E �p 1Z W N .e�� LL¢Z O www .-0 O O'"ZZ °C� ¢a x�'v�o00z v� NZZZfLLUiwr 2°` z Z� xz "'x m < 00 NdLL f�a Z w \ K O n00000 O O J m H C9�a zlFa K NuUmd U V Z Zum ]C K W m �U�3 m n d 0¢ OVA W ~»— Y V W 00� W N m ¢ QaO.- W .E J �� 0 0 m''8 n H ¢=zI SI Q¢iNNmmuuoo ()::iLLa3V1rK FN> in FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. *****************Applicant fills out this section***************** * w APPLICANT: 4 " �e� �1�1' - �� Phone LOCATION: Assessor's Map Number G%�� Parcel Subdivision u.-I�zl Lots) Street �O �/.'/�✓J Jy-, St. Number to 0 ************************Official Use RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments ?'6004 1'_ . Comments &W Food Inspector -Health Septic Inspector -Health Date Approved Date Rejected 0 Date Approved .? Date Rejected Date Approved Date Rejected Date Approved L Lg 4xff_ Date Rejected Comments _-�- AJ c -o 0,6) iu 5 `) - -P/c/c A %C) Public Works - sewer/water connections / �Z - driveway permit xl Cz Z7 �s k Fire Department Received by Building Inspector Date DEC 3 0 LAWRENCE RICHARD J. D-AGOSTINO CLEMENTEABASCAL JAMES M. GARVEY METHUEN STEPHEN CAMPAGNONE GERARD A. THIBAULT GREATER LAWRENCE SANITARY DISTRICT DONALD A. GEORGE, EXECUTIVE DIRECTOR January 5, 1994 Mr. James Diozzi North Andover Plumbing Inspector 120 Main Street North Andover, MA 01845 Re: Discharge Approval 60 Willow Street, North Andover Dear Mr. Diozzi: ANDOVER ROBERT E. McQUADE NORTH ANDOVER GOODLOE SUTTLER , SALEM, N.H. JOSEPH W. GAGNON ATTY. JOHN T. POLLANO, CPA TREASURER This office has reviewed the proposal by Mortin International for a facility at 60 Willow Street, North Andover. Also, the District has contacted the South Essex Wastewater Facility in order to research the compliance history of the Mortin International Company and found that they have, over the past few years, been in suitable compliance. Although South Essex issued a discharge permit, the District does not see any need at this time to do so, because the proposed facility's operation will not generate a significant wastewater discharge. The District did advise that limestone canisters be installed under the laboratory sinks or one central large tank to provide for consistent pH discharge to the sewer. This letter is to serve as conditional approval to Mortin International to discharge process wastewater to the District. If the discharge flow rate exceeds 10,000 gallon per day in the future, the District will review the discharge for possible permitting. The District is requiring engineering drawings for the facility within a reasonable amount of time, at which time the District will begin to track this site until wastewater is discharged in order to protect the District's operation. This approval is conditional upon inspection of the facility to evaluate any wastewater concerns, before the facility becomes operational. 240 CHARLES STREET • NORTH ANDOVER, MASS. 01845-1649 • TEL. 508-685-1612 FAX: 508-685-7790 4 Mr. James Diozzi January 6, 1993 Page -2- If you have any questions or concerns, please feel free to contact me. Very truly yours, GREATER LAWRENCE SANITARY DISTRICT n P. O'Hare ndustrial Pretreatment Inspector %rtan Morton Specialty Chemical Products SHIP 7'U MORTON INTERNATIONAL, INC PERFORMANCE CHEMICALS CONGRESS STREET BEVERLY MA 0191S SUPI-11JER 3b4r., CHANNEL BUILDING CO., INC 242 NECK ROAD ..,.. ......., .� C'iltOER DATE I f )lMER Ni IM141 / ... ORIGINAL 1/03/94 3 w�11(J ORDER CONFIRMED MTN DO N(7 DUPLICATE HAVE.RHIL.L MA 01835 IAIPORTI3NT; RENDER 1NVUIC-FS IN Du1;/.ICATE TY7 SEE BELOW — 1 LT 40511 ooO74C�41D .pkbViDe :ALL MATERIAL' ` LAE3f��t 44£3731 .c���c�f.1 1448731 .� TOOL,,, EQUIPMENT: AND SUPERVISION TO RENOVATE THE LEASE SPACE AT 60 ' WlLLZAMS STREET, N. ANDOVER, MASS:. PER PRbjECT SCOFRE AN[) ' ARCiHITECTURAL; ELECTRICAL; MECHANICAL, HVAC.At�D EQUIPMENT DRAWINGS (IN YOUR FflSSES£;TQN? FOR A FIXED FEE ANCD'.FER YOUR. PROPOSAL DATED DEC. 15, 1993, T'HIS PURCHASE ORDER TO INCLUDE BUT NOT NECESSARILY LIMITED TO THE FOLLOWING: RENOVATE THE 1 r -FICC SPACE PER DESIGN DRAWINGS, RENOVATE THE LAB SPACE PER DESIGN DRAWINGS. PROVIDE UTILITY PIPING D113TRIBUTION PER DESIGN DRAWINGS, PROVIDE ELECTRICAL. POWER DISTRIBUTION PER DESIGN DRAWINGS. PF;OVIQE HVAC, BOILER AND ALL OTHER EQUIPMENT PER DESIGN DRAWINGS. PROGRESS PAYMENT WILL BE MADE 10'd 006V£L£Q08 'ON XVd 00 0018 1BNNdHO - -- GU Q - H:11 IN8 V6 -LO -NSI' C)ELIVERY DATE FREIGHT TERMb 6/01/94 .. PAYMENT Tams NET 30 SHIP VIA TAX EXEMPT 363-640-052 M)FRAL I..O, NO, -36-3640053 cAR/PRaJ� 51306 TI 11 S ,:)RDER IS SURIF,CT TO THF TERMS AND CONDITION5 SHOWN' C: 80TI{ THE F'ACF. AND BACK OF THIS ORDER. 1 LT 40511 ooO74C�41D .pkbViDe :ALL MATERIAL' ` LAE3f��t 44£3731 .c���c�f.1 1448731 .� TOOL,,, EQUIPMENT: AND SUPERVISION TO RENOVATE THE LEASE SPACE AT 60 ' WlLLZAMS STREET, N. ANDOVER, MASS:. PER PRbjECT SCOFRE AN[) ' ARCiHITECTURAL; ELECTRICAL; MECHANICAL, HVAC.At�D EQUIPMENT DRAWINGS (IN YOUR FflSSES£;TQN? FOR A FIXED FEE ANCD'.FER YOUR. PROPOSAL DATED DEC. 15, 1993, T'HIS PURCHASE ORDER TO INCLUDE BUT NOT NECESSARILY LIMITED TO THE FOLLOWING: RENOVATE THE 1 r -FICC SPACE PER DESIGN DRAWINGS, RENOVATE THE LAB SPACE PER DESIGN DRAWINGS. PROVIDE UTILITY PIPING D113TRIBUTION PER DESIGN DRAWINGS, PROVIDE ELECTRICAL. POWER DISTRIBUTION PER DESIGN DRAWINGS. PF;OVIQE HVAC, BOILER AND ALL OTHER EQUIPMENT PER DESIGN DRAWINGS. PROGRESS PAYMENT WILL BE MADE 10'd 006V£L£Q08 'ON XVd 00 0018 1BNNdHO - -- GU Q - H:11 IN8 V6 -LO -NSI' Jifforton Afortun Specialty Chemical Products SHIP 7*0 MORTON INTERNATIONAL, PERFORMANCE CHEMICALS CONGRESS STREET INC SEVERLY NC- SEVERLY MA 0191S SUPPLIER 3640 CHANNEL BUILDING CO., INC Z4Z NECK ROAD PURCHA,SE ORDER T -I ORIGINAL 1 /;3 :3 f"4 3()94,C)o ORDFX CONFIRMUD WITH DO NOT DUPLICATE mraVERYDATE 6/01/94 PREICWTTERMS PAYMENT TFRMS NEI' 3o SHIPWA TAX E*XEMPT HAVERHILL MA 01835 363-640-O53 IMPORTANT.- kENVER INVOICF5 IN DUP1,17FE TO FEDFRAL 1,L), No. 36-3640053 CAR/PROJ# 51306 THIS Okl)EX 15 SUBIECT TO THE TEWOS AND CONDITIONS SHOW"'; BOTH 711E PACE AND BACK OF THIS ORDER, ATtN -,...F.RAVIN MEHT4,. --'CONFIRMING 'OR0ER.******. DO. NOT.: DUPLICATE FER AI.I. C0A,1MZ.rNjC-,1-jj0NS THIS (),1? RSGARDING DE R 4 9 7 4.7TH R1 11c OM'. 4" 60'd 006PELES09 'ON XV, 00 MIS 13NNVHO LZ:11 lad V6-LO-NVf 0 z ui om c CD 0 m C C s CD c O N i+ C • �p O CLc m m m ,= OC O cc '� N w Q E Q �o c 1 44" CM c N _m i m C � O ico N N ` lu m 01 m Q N C ev � N CLL) N m � Ift V' CD %mof cc O NCD CD aC a r.+ m L 'r m W G 4; �.., -p = ZO R �+ H N 'a= C WE V co 'p C3 L - C2 m p CO _y a CD O 0C = m L-= Go .a N= f- r 4- a.., m O CL N _ N O N C O ev cm m a C13 0 cm C C O N m Z O Z 0 8 CDI- 7. w O F U w a aA z U w z � Q � o w � iv � io V C w � w w U c rL c CD 0 m C C s CD c O N i+ C • �p O CLc m m m ,= OC O cc '� N w Q E Q �o c 1 44" CM c N _m i m C � O ico N N ` lu m 01 m Q N C ev � N CLL) N m � Ift V' CD %mof cc O NCD CD aC a r.+ m L 'r m W G 4; �.., -p = ZO R �+ H N 'a= C WE V co 'p C3 L - C2 m p CO _y a CD O 0C = m L-= Go .a N= f- r 4- a.., m O CL N _ N O N C O ev cm m a C13 0 cm C C O N m Z O Z 0 8 CDI- 7. O s O co 0 co L _ o o v z co CL CD CO) D � � c � C p� y m m CO o Co CL H'C., CD CD L L m o d d. c Q CO2 CD '�.., C cv ca v J� 'o. o co z co CL V N2 � C _R d CO2 0 J Q Z LL - z 0 Q cr w Cn z 0 U w O F w a z w � U � w � iv � io C w � w O s O co 0 co L _ o o v z co CL CD CO) D � � c � C p� y m m CO o Co CL H'C., CD CD L L m o d d. c Q CO2 CD '�.., C cv ca v J� 'o. o co z co CL V N2 � C _R d CO2 0 J Q Z LL - z 0 Q cr w Cn z 0 U MORTON INTERNATIONAL R&D LABORATORY Morton International's research and development laboratory employs approximately thirty-five chemists, engineers and microbiologists to develop industrial applications for three major product lines. Sodium borohydride is an inorganic reducing agent used to bleach paper, treat industrial effluent streams and in the production and purification of various chemicals. Our Industrial Biocides are employed as additives in plastics to prevent the growth of mold and mildew on articles such as shower curtains, pool liners, vinyl upholstery, carpet fibers etc. Magnesia Chemicals such as magnesium hydroxide and magnesium oxide are employed in consumer products such as milk of magnesia and as additives for plastics and rubber. The laboratories store and utilize approximately nine hundred chemicals of various types, most in quantities of less than a few pounds. Flammable solvents are stored in approved containers and safety cabinets. Total inventory of flammable and combustible liquids is less than 300 gallons. The laboratories have an active safety program with a permanent safety committee and a documented Chemical Hygiene Plan, as required by OSHA. Engineering controls (fume hoods, ventilation system, equipment safety devices etc) are employed, along with personal protective equipment and approved storage facilities for solvents and chemicals. All chemical wastes are stored and disposed of according to federal and local regulations. Employees receive safety training at the time of hire, and annually thereafter, which includes hazardous communication (MSDS, labeling etc), waste disposal procedures, '.ab safety training and use of personal protective equipment. During the past thirteen years of operation of this laboratory at the Beverly, MA. site, there have been no lost time accidents (over one million man-hours). Lar J. Guilbault Vice President, R&D 'Ionon P -r or -;tante +" ernicais iriternataonat. ;itc., .: 0 ri;arrorer ;freer. tivers..V.4 o1923-;- 80 '08/774-3100 :'ax 508/927-675 pJ a' CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: T $ James Bourgeois HEREBY CERIVIFY 1-11AT THE *8UILDING CONSTRUCTED AT 60 Ali I I ow Street North Andover MA DOES CONFORM IN ALL RESPECTS TO THE I" EASSACHUSE;TTt'S SIVA'fE"; BUILDING CODE. AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: *ienant improvement construction for Morton International, inc. as depicted on permit drawings. r l %t=i`fL:f'. i_)f'. it} O/=�^.•� N•�r i. r r 'N PPF ` 111 .fi.`Y1 /t \JH NOR B ll ANDOVER S :ir S M, o,: r ti!Ir •r.•t \iS!lii\'r'f IAVIti J ttI f;...�,;t!!litir iitii))f�v:i Y F KALI: 1 ;.i'. N1_.L.S'.)N, I I1tL_i.:; CERTIFICATE OF ENGINEERING BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 GENTLEMEN: T $ James Bourgeois HEREBY CERIVIFY 1-11AT THE *8UILDING CONSTRUCTED AT 60 Ali I I ow Street North Andover MA DOES CONFORM IN ALL RESPECTS TO THE I" EASSACHUSE;TTt'S SIVA'fE"; BUILDING CODE. AUTHORIZED SIGNATURE: DATE: REGISTRATION STAMP: *ienant improvement construction for Morton International, inc. as depicted on permit drawings. 3llwton SENT VIA FAX 6 January 1994 Mr. James Diozzi Plumbing and Gas Inspector Town of North Andover 120 Main Street, North Andover, MA. 01845 Dear Mr. Diozzi: ,r -!AN 10 1Pc1 J The Specialty Chemical Products group of Morton International is in the process of relocating their existing Research and Development (R&D) facility from Beverly, Massachusetts to North Andover, Massachusetts. Presently, our Beverly facility does not have any wastewater treatment facility. Our wastewater discharges into the Southern Essex Sanitary District treatment system. We record the discharge water pH to.insure that the wastewater pH is•within- specified .legal limit. All our, employees .are trained, and• instructed -to neutralize the acid and alkaline solutions prior to discharging into the -laboratory sinks. Misters Greg Wiech from Channel Builders, Jim Erricolo from J&E Mechanical and Pravin Mehta from Morton International visited the Greater Lawrence Sanitary District. We met with Mr. John O'Hare, an industrial pre-treatment supervisor of the Lawrence Sanitary treatment facility and discussed with him our R&D facility wastewater discharging into their treatment system. Mr. O'Hare indicated that he contacted his colleagues at the Southern Essex Sanitary District and found out that they do not have any problems with the Morton facility. Mr. O'Hare will issue us a letter indicating that he does not see any problems with the pH of the wastewater liquid from Morton will be discharging into their treatment system. Mr. Greg Wiech called and discussed the relocation of Morton's R&D facility plans with Mr. Mohamad Ahsan of the Dept. of Environment and Protection Agency in Woburn, Massachusetts. He agreed with our explanation and indicated that the treatment system.is.not required•if;Morton-maintains.the wastewater: pH • within the specified limits., We don't see any.problems in ' meeting the pH requirements. -Upon receipt, we will complete -,and then forward the application forms to Mr. Ahsan for his review and approval. Morton International, Inc., 100 North Riverside Plaza, Chicago, IL 60606-1596 312/807-2000 3s. -_ d 3 Lit cu V) �ml 0 C, T 1 J w 7 Z 0 �. Oj In C, . L 3 a.a. d ` 0 C, T 1 J w 7 Z 0 tL)Ate` Ur NUKIN ANUUvtt.;( CON, -RUCTION CONTPOL PROJECT NUMBER: 06 0 (5 33) 682-6483 x3;1 PROJECT TITLE: iVicrton lnternat i ona i + PROJECT LOCATION: 60 Oli i lOw Str?Qt, worth Andover, NAME OF BUILDING: NATURE OF PROJECT: T a L.i mnr.ovrt ia;)atory atLi assrCjated off #('� rn IN ACCORDA.gC£ WITH SECTION 121.0 VF ;Hr USSAMSETTS STATE SE�II.DI#�., Yl `' COBE, ' (/ 'QGl Reg'strati tt iso. #' "7 BEING A l?FGZST£REL PRCFLS^ CNAL 4== ` ARCHITECT HCREBX CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DE5ICN PLARS, CGS4r��TATYt�IiS ANDSi'ECIFICA- TIONS CONCERNINC: ENTIRE PROJECTSARCU11TECTURAL STRUCTURAL MECHANICAL (� FIRE PROTECTION ELECTRICAL OTHER (spetify)f= FOR THE ABOVE NAMED PROJ£C°r PUND THAi , TO THE FEST OF MY KvO'�aL4 H PLANS, COMPUTATIONS AND SPECIFICATIONS MEET TXE'APPi,ICA2LE PROVISIONS DOF''TP?�:C�.ASSACh'USETTS STAT£ BiiIIiS1idG CODE, ALL ACtirEPT4ZLE ENGINEERING PRACTICES. AND APPLICABLE LAWS AND ORDINANCES FOR TkE PROPi3SED tSE AND OCLCIPANGY. I FURTHER CERTIT-Y THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND RE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO ""',,."NE 2iiAT THE E10RK IS FFOCE£DING IN ACCO RDANCE WITH THE ;DOCUl-A.FNTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOA THE rOLLOWING AS SPECIFIED IN .SECTION 127 1, Review of . 2.2: mract ,sanies artier , trdttals of LSe =�stor as required by t.� ctxzsccion ttmcxact � atAr�itt:ed z�nx buil to the design concept. Fe*,ni_, wid approval for canfcrnncz 2. Review and appro-gal of the qut1iCy cosi_ul prc a e rmterials. ams fes all c- rtsg;ired tonuolled 3. Special arrhitectuni or Wigireering �ci.fieprofesslc»l.in t+ requirirV controlled tmterf,,als ez riors `�ic+ri of �tital c u%rcrion cnTpcTj._ s .� t;�a lisin Ap,^ -at zcnsrr` B. d in t.'x accepted erig£twering practice PURSUANT T'0 SECTION 127.2.3, 1 SHALL SUBMIT WF_EK T Y A PROG:�£SS REPORT To WITH PERTINENT COMMENTS TO THE NJRfli iNj)4` L:a. B01' JI�� INSPECTOR �.�_t6_itE9 UPON COMPLETION OF THE WORK 1 SHALL g �41� Ow SUBMIT A FINAL 1� EP[t T AS To SA(S* oRy COMPLETICSN AND BEADINESS OF THE PROJECT FOR OCCuPA1:cY. 10 7-57 �y ARI, i�?iarOtd. SUBSCRIBED Alto S OR?i TO BEFOREBEFOREHE THIS /�DAY OFJ SIGNATURE 2 4C � �f rN OF MaS N0T,+►RY FllBit LI tfy COMMISSION EXPIRES '�- -VZLR Na� U n D J r� E d y C42 y c O ' v c m 0 cm c �c N m t o. Z O O F. 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PROJECT: MORTON INTERNATIONAL NORTH ANDOVER BUSINESS PARK LOCATION: NORTH ANDOVER BUSINESS PARK 60 WILLOW STREET NORTH ANDOVER,MA. 01845 DATE:December 6, 1994 REGARDING: FINAL CERTIFICATE OF OCCUPANCY DEAR BOB: PLEASE FIND ENCLOSED THE ARCHITECT LETTER OF CERTIFICATION CONCERNING THE ABOVE PROJECT. ALSO ENCLOSED ARE THE BUILDING CARDS ISSUED FOR THIS PROJECT. AS YOU RECALL, THE PROJECT WAS ISSUED ONE PERMIT CARD AT THE DATE OF PROJECT COMMENCEMENT. DUE TO THE PHASED OCCUPANCY FOR THIS PROJECT, YOUR OFFICE ISSUED ADDITIONAL CARDS FOR EACH PHASE (I,II,III) OF THE PROJECT IN ORDER TO PROPERLY TRACK EACH PHASE. WALTER CAHILL AND THE RESPECTIVE ELECTRICAL, PLUMBING, GAS INSPECTORS OF YOUR OFFICE AS WELL AS THE NORTH ANDOVER FIRE DEPT. HAVE OK'D THE VARIOUS PHASED OCCUPANCIES AS THEY OCCURRED. AT THIS DATE WE ARE REQUESTING A FINAL CERTIFICATE OF OCCUPANCY FROM YOUR OFFICE. PLEASE ADVISE IF YOU NEED ANY FURTHER DOCUMENTATION OR SITE VISITS CONCERNING THE ABOVE. SINCERELY: S. E. FOSTER W - i IAcll. r TQ:ROBERT NICETTA, BUILDING INSPECTOR ORGANIZATION: TOWN OF NORTH ANDOVER, MA. PROJECT: MORTON INTERNATIONAL NORTH ANDOVER BUSINESS PARK LOCATION: NORTH ANDOVER BUSINESS PARK 60 WILLOW STREET NORTH ANDOVER,MA. 01845 DATE:December 6, 1994 REGARDING FINAL CERTIFICATE OF OCCUPANCY PLEASE FIND ENCLOSED THE ARCHITECT LETTER OF CERTIFICATION CONCERNING THE ABOVE PROJECT. ALSO ENCLOSED ARE THE BUILDING CARDS ISSUED FOR THIS PROJECT. AS YOU RECALL, THE PROJECT WAS ISSUED ONE PERMIT CARD AT THE DATE OF PROJECT COMMENCEMENT. DUE TO THE PHASED OCCUPANCY FOR THIS PROJECT, YOUR OFFICE ISSUED ADDITIONAL CARDS FOR EACH PHASE (I,II,III) OF THE PROJECT IN ORDER TO PROPERLY TRACK EACH PHASE. WALTER CAHILL AND THE RESPECTIVE ELECTRICAL,PLUMBING,GAS INSPECTORS OF YOUR OFFICE AS WELL AS THE NORTH ANDOVER FIRE DEPT. HAVE OK'D THE VARIOUS PHASED OCCUPANCIES AS THEY OCCURRED. AT THIS DATE WE ARE REQUESTING A FINAL CERTIFICATE OF OCCUPANCY FROM YOUR OFFICE. PLEASE ADVISE IF YOU NEED ANY FURTHER DOCUMENTATION OR SITE VISITS CONCERNING THE ABOVE. SINCERELY: S.E. FOSTER V Z a M O ca W �.. M L O W w aL W 0 110 ev G E. r r A Z o � o G7 v A N U ~ 00 W H x 4-4, z o o 4-)mz m a) . (2)z �' 0 - o U U N +� Cc o o�� WvW U) cA co rx� >4 41 w HA�� 04 0W 0 O� o6� x •'. � nt E.y C `.' H�ti � 44 r Engineering f« Development & construction Inc. December 1, 1994 Channel Building Company 242 Neck Road Haverhill, MA 01835 Attn: Steve Foster, Project Manager Re: Morton International Tenant Fit -up 60 Willow Street North Andover, MA Dear Steve: Please be advised that to the best of my knowledge, information and belief, the above referenced project has been designed, constructed, and inspected in a manner in which complies with the State Building Code and other applicable laws and ordinances. Sincerel , James Bourgeois, RA President, EDC Inc. JB/cp NEW MEADOWS PROFESSIONAL BUILDING PHONE (508) 887-8586 E,R9 ARCy� f� �S Bou F No. 4757 FORD, �S, A iH Of M 447 OLD BOSTON ROAD TOPSFIELD, MA 01983 FAX (508) 887-3480 Z 0 v aN W rn ti il Ll . c c ' m c O � C H • O C * V CD Q C #a O N Q'11Ecia O _3 co �ES IL 0 c � c •ate • , N R 'i m al o � 3co) qF* CD Q� m J =Ca C Q N Cp N m G V� �cm¢ o. c V y O • �c o 0 _ WE a.+ p F- N m f - W C Cc ~ •N •+ oc *E v -v v •N ui cm L.2 m p m C COD CL W.O _ A = i .=N -O H Z 0. a*m C17 k a x z w Z3, � L 0 1 a z z Z °D _4Z mUs H E �ro W57 > m co ° G v w° U) w a°' J)w w W V)cn Ll . c c ' m c O � C H • O C * V CD Q C #a O N Q'11Ecia O _3 co �ES IL 0 c � c •ate • , N R 'i m al o � 3co) qF* CD Q� m J =Ca C Q N Cp N m G V� �cm¢ o. c V y O • �c o 0 _ WE a.+ p F- N m f - W C Cc ~ •N •+ oc *E v -v v •N ui cm L.2 m p m C COD CL W.O _ A = i .=N -O H Z 0. a*m C17 k J o z E C L 0 Z °D O H E CD c z o ce — cc m m z � L o fr C . � a ai L i CD . 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This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLI CANT: T 7o N LOCATION: Assessor's Map Number Subdivision iV� r 0 c S reet 60 (w'r1l6`„s S� Phone _ Lv E� l- F&y Parcel IF Lots) St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway ce Fire Department N .,_� t Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date ;7 ISP -14 [A Oo 7r—NANT' PEM161NO WALL (2 MR) 41 41 vm i MORTON INTERNATIONAL 60 WILLOW ST. NORTH ANDOVER,MA. SCOPE OF WORK; INSTALL NEW METAL STUD/GWB PARTITIONS NEW S.C. BIRCH DOORS & STEEL K.D. FRAMES NEW WINDOWS TO MATCH EXISTING (T.M.E.) RELOCATE/ADD SPRINKLER HEADS AS NECCY PER NFPA-13 EXIT SIGNAGE/EMERGENCY LIGHTING PER CODE CONVENIENCE OUTLETS AT EACH WALL PER OWNER NEEDS REUSE EXISTING LIGHT FIXTURES REVISE LIGHT SWITCHING FOR NEW OFFICE LAYOUT NEW ACOUSTICAL SUSPENDED CEILING EXISTING FLOORING TO REMAIN EXISTING HVAC TO BE MODIFIED FOR NEW LAYOUT PER CODE REQMTS ALL WORK PER MASS STATE BUILDING CODE AND LOCAL JURISDICTION W, L -10 171 7C Cn z G v � y C � 0 x �---� �y .-_ m o cm Ty "o n O r Cl) Z CO) CD O Z1 CL r— c*j d CD y O CD O CDCL o CD n Er CD O CD zW m pp C. CD N! c. v y C) co CD z o y O O Z O .Cl) O � CD T z D O C CD r O .om C? 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M C z v 7 a C� .O O 0 H n CD Cl) Z cn D O 'O sz r o• o d =• y >C = O •� CD O � CD o CrCL a) CD CD O CD vow � O CD yCD. CZ O y � CD I S v W O Z CD O CD O C CD 0 JU G. 0 O O W N 0 _ co O W S. 5' to CD 0 _ H G 0 CL H h c?-!�0 d Z _. N O C N d O < m .O C4 m 0m nn CL m cD C a' �-2.D h _1 CD dd.► H T CD -1 0 o y c y D m CD 0 0 \1 a o , = 0 z5LA..c; G 0 CD V CD 7� n = . CL �,`a o C r". CD :O o m CM CD 3 N Ol N Gd W Q C �i0 C ca O H H 1 = O O W .� to C^ CD 3 CD : 1 J 1� U coCD O 0 sCD dd: 0 CU = o C_: O = = GD, cn J 7 'IT z S y z z T � z � rl z o r z o o ITI � J Kil 0 c Town of North Andover 40RTH OFFICE OF 3� ° '6 Al 0 COMMUNITY DEVELOPMENT AND SERVICES O A 27 Charles Street '� }• �o WILLIAM J. SCOTT North Andover, Massachusetts 01845 X-1 SACHCH US' -E S S Director (978) 688-9531 Fax (978) 688-9542 In accordance with the provisions 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 a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: S+ of F/Acility) Signature of Permit Applicant �'- 5-99 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPE:�,L.S 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-95.10 PLANNING 688-9535 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICA-NT fiLLS OUT THIS SECTION*********************** APPLICANT Or �17r �Y`rrE^ `�Oh°l PHONE a LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) _ STREET 4C) l l>� 1`��tiv ST. NUM13ER�O *****************************OFFICIAL USE ONLY J At rAr **R�or * o**W'-"�* RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMMENTS TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED. DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT e S� RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm �� The Commonwealth of ititassachusetts Department of Industrial Accidents Med 91IMS&Mfons 600 Washington Street �. Boston, Mass. 02111 worxers' Compensation Insurance Affidavit name: 1 ` QV- TOYN T h ICY�nrw �V�e locatiom b0 u.\:��Lw City ,V 1 V, t qy-t, W V. U \Y.1 1' phone t `i i r-6 p9-• (S -L10 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. j comQanv name: qA}� �el,1'�e. � C e -,A �CLc `'£ S address: ...... city' phone #7 imurancc co. Policy # I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company nsme: city-, phone #• itilarance coy. _ori CV" .. ._.. ... Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a Fine up to 51,500.00 and/or one years' impnsonmcnt as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of rhe DIA for coverage verification. I do hereby cenify under the pains and penalties of perjury that the information provided above is true and correct Si Print name ne 4 official use only do not write in this area to be completed by city or town official city or town: permit/license # riBuilding Departmeat FILicensing Board [✓ check if immediate response is required C]Selectmen's Office CHcaith Department contact person: phone N; --0 Other (muga 3195 PJA) �Vmforton May 6, 1999 Mike McGuire Town of North Andover Office of Community Development & Services 27 Charles Street North Andover, MA 01845 Mike, Attached is the layout for the nine office retrofit at 60 Willow Street. The yellow area is new offices being built and the green is the two walls I need to remove. in addition, two new windows will be installed as marked. I have received proposals from the following contractors: Piquette & Howard Electrician $12,500 J&E Mechanical Plumbing, Sprinkler & Demo $4,100 Horizon Metals . Ventilation & A/C $21,699 Walls Unlimited Sheetrock & Demo of existing walls $14,050 Total Cost of Job $52,349 I have enclosed copies of the proposals and Certificates of Liability Insurance Sincerely, John Evans Facilities Supervisor Morton Performance Chemicals Morton International, Inc., 60 Willow Street, North Andover, MA 01845-5917 508/774-3100 Fax 508/689-1555 r„-n.c1 . LZI;;-1 1r.;C r'I•I \CAo\aNDOVEp,154\9902\9902LOI EON CI�v1RLN"W'iG11ML oCl Tut Apr 27 11:31.09 1999 N0.644 P.i 0 0 05/0311999 04:07 6034345812 HORIZON,NH PAGE 01 ML 2 WINDi AM DEPOT RD. DEJ RY. N.H. 03038 Pbm 6M4324901 Fm 603-434-5812 May 03,1999 MORIVN INTERNATIONAL 60 FLAGSHIP DR. N. ANDOVER, MA 01841 ATM JOHN EVANS RE: H.V.A.C. PROPOSAL FIT -OUT FROM: PAUL LANGLOIS PROVIDE THE FOLLOWING SCOPE OF WORK: I. NEN OFFICE AREA * ONE LENNOX 6AS/ELECTRIC PACKAGED ROOF TOP UNIT. THIS UNIT,, HALL BE 460/3/60, NATURAL GAS FIRED, BAROMETRIC RELIEF AND TIED INTO I AE BUILDING D.D.C. SYSTEM *PROVIDE A COMPATIBLE MR -24 ROOF CURB INSTALLED INTO THE EXI: TING BUTLER ROOF *GALVANIZED DUCT DISTRIBUTION TO LAY -IN DIFFUSERS ON INTERI )R SPACES AND SLOT DIFFUSERS IN THE THREE PERIMETER OFFICES *PROVIDE DUCT WRAP INSULATION SUPPLY AIR DUCTWORK *PROVIDE A SINGLE POINT RETURN TO COMMON AREA. (OFFICE DOOR; SHALL BE UNDER CUT TO ALLOW RETURN AIR BACK TO RETURN a. DaSTtNG LIBRARY AREA *ADD A NEW (4') 2 SLOT DIFFUSER TO ACCOMMODATE THE THREE OFF] :ES CREATED ON THE PERIMETER *DUCT RETURN AIR BRANCHES BACK TO EACH OF THESE OFFICE5 OT Tl RMINATE AT A RETURN GRILLE (EG"RATE) IN THE CORNER OF EACH OFFICE in. VMTIN6 PERVAETER OFFICES "DIVIDE THE SIX OFFICES INTO TWO SETS OF THREE *ADD A NEW VAV BOX WITH HOT WATER REHEAT *REDUCT THE SUPPLY DUCTWORK AS REQUIRED. RETURN DUCTWORK ; -iALL REMAIN AS INSTALLED *ADD A NEW ELECTRIC THERMOSTAT IN ONE OF THE OFFICES TO CON rROL THE VAV BOX IV. &AS PIPING - TIE IN NEW ROOFTOP UNIT FROM EXISTING MAIN 05/03/1999 04:07 6034345812 HORIZON,NH PAGE 02 PAW 4? QLAM9 770V V. HOT WATER PIPING *PROVIDE PIPING AND INSULATION TO NEW VAV BOX Vi. ROOF CONDENSATE PIPING - FROM RTU TO ROOF GUTTER (ROOF WARRANT i) VII. COC CONTROL *PROVIDE A NEW DDC CONTROLLER, DISCHARGE AIR SENSOR, ROOM SEN 5OR AND AIR FLOW SWITCH. (DUCT SMOKE DETECTOR WILL BE SUPPLIED BY PICC JETTE AND HOWARD AND INSTALLED IN THE DUCTWORK BY HORIZON) VIII. CRAM, SALES TAX, START-UP AND SERVICE (1 YR. WARRANTY) E7�.t�'�ONS *ELECTRICAL POWER *PATCHING *PAINTING BAW FIdM: $21,699.00 CORD :. ;;.:..... ..... • : •.• ..: .�:.:°:.;•;;t,. �. ������ ��':. L��B���`T�' �������• Es DATE(MM/DWYY) PRODUCER ... THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION Rodman Insufia>zce A4�ay� Iaa ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE � 75 :Fells Ave HOLDER. THIS CERTIFICATE D©ES NOTAMENQ, EXTEND.oR Newton. MA 02459-3297 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AFFORDING COVERAGE Jeffrey Grosser PeoneNo. 617-S27-3000 FwtNo. 617-965-2947 COMPANYCOMPANIES A Royal Insurance Co INSURED COMPANY B EBI Companies Horizon Metals, Inc.. COMPANY Paul O'Loughlin C 21-23 Westech Dr. TYn9sb0r0u9h MA 01879 COMPANY :..:.:::..... Rik.........:............:.:::::::.. ,.::..:...::::..:.::..... . 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 CERTIFICATE AAAI BE ISSUED OR MAY PERTAIN, THE INSURANCE OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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. YPE OF INSURANCE POLICY NUMBER LTRJGENERAL POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) UMrM LIABILITYG AERCIAL GENERALUABILRY ASP2384390000 ERALAGGREGATE S 2 000000 12/31/98 12/31/99 PRODUCTS'-COMP/OPAGG MADE a OCCUR SLAIMS 1 OOO, 000 OWNERS & CONTRACTOR'S PROT PERS ONAL&ADV INJURY $1000 000 X . e rate' li:Ttit EACH OCCURRENCE $ 1,000,000 'Der project FIRE DAMAGE (Anyone file) S 50,000 AUTOMOBILE LIABILRY MED EXP (Anyone Person) S 510P6 A F7,ANYAUTO AI=19035. 12/31/98 12/31/99 COMBINED SINGLE LIMIT S 1,.000,000. ALL OWNED AUTOS X SCHEDULED ALrrO5 BODILY INJURY S (Pet person) X HIRED AUTOS X NON -OWNED AUTOS BODILY INJdenURY S. (Pereccit) PROPERTY DAMAGE $ AUTO ONLY - EA AC 4DEW OTHER THAN AU('O ONLY: .: EACH ACCIDENT $ 60ARAITY ITYAGGREGATE $.EACH A FORM PLA3631360000 OCCURRENCE S1,000000 12/31/99 12/31/99 AGGREGATE N UMBRELLA FARMPENSATION $ 1000000 AND EMPLOYERSrLIABILI Y $ WCSTATU- ':,::ra;,,�:: ;;;:::>;a::..::,:,:.:•:: TORY LlMRS ER THE PROPRIETOR/ H DARTNERSIE)�CUTIVE X INCL 375203 EL EACH ACCIDENT $100,00a 12/31/98 12/31/99 ELDISEASE-POLICYLIMIT, S500 000 OFFtcERs ARE: E=L a Hl:R EL DISEASE. EA EMPLOYEE $ZOO O10 Contractors Coverage Extension End, (GC 0300) included MORTO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY wlt,LENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Morton International BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Central Engineering Dept. OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, 100 N. Riverside Plaza, 30T AvrHORrZED REPREAmaAwE Chicago IL 60606 G 1S FROM P & H ELEC FAX# 508-685-7936 PHONE NO. : 0 �L b J~ kMorton International 60 Willow Street North Andover, MA 01845 Attn: John Evans May. 05 1999 08:27RM P1 April 30, 1999 Re: Office Renovation Piquette and Howard Electric is pleased to offer the following proposal on the above referenced project. To include: 1. Disconnect existing office partitions. 2. Refeed new office partitions from existing circuits. 3. At this time, I have know idea how many new office partitions there may be or there layout. I have added (5) new circuits and (5) new telepo.les• in addition to what is presently there. 4. Electrical demo of back area and dividing wall. 5. Relocate existing Fire Alarm. 6. Add two emergency lighting units. 7. Lighting and receptacles for (9) new offices, approx. 44-2X4 fixtures, 46 outlets and 10 switches. 8. All phone wiring by others. 9. Due to the available space in the existing electrical panel, it may be'necessary to add a'new panel or increase the size of the existing panel to accomodate all the new circuits. 10. Furnish and install new 480V, 30, 50A feed for a new AC unit on roof. Control wiring by HVAC Contractor. 11. All wiring to be copper and MC type Cable. Total Thanks for the opportunity, Robert B. Howard President RBH/ 59 AMES STREET a LAWRENCE, -MA 01841 i (508)•685-6145 w (608) 687--7910 APR -29-1999 PRODUCER 10:16 FROM NORTH ANDOVER INS. AGENCY TO 6891555 P.02 AR 01 4 /29/99 .. ... ... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND ONO No RIGHTS UPON T"P. CUITIRCATE HOLDER. THIS CER111FICATE DOES NOT AMEND, MMD OR ALTER THE COVERA416 AFFORDF-D 5V THE MT Poster Insurance Services, Inc. compANiES AFFORDING COVERAGE 9 Wavcrly Road ......................... ..... ........... ........... I .................. . .......................... . ............ .............................. North Andover, MA 01845 COMPANY A ...... PRODUCTSCOMp/OP Am X COMMERCIAL GENERAL LIABILITY................................. ....... S f..0 0 0.1.0 0 0 .......... I ........... .......... PERSONAL A ADV, INJURY CLAIMS MADE: X OCCUR.;: .............. I ..... . . .............. 811. ....... LEITER ...................... I ............ UTICA ...................................................................... MUTUAL INS CO ............................................................ ............. ................ ................................ 1- ........ ............. ......................... COMPANY LemUTICA ......... LIMIT...... MUTUAL INS CO .......... .................... CO upep .......... .................. .............. ..................... HIRED AUTOS BODILY KIM (Per RcQww* $ PIQUETTE & HOWARD ELECTRIC SERV INC COMPANY LFITER C ...................... ........ UTICA ...... I .............. MUTUAL..... I.N.S.....C.O ............. ................................................ 59 AMES ST LAWRENCE MA 01841 COMPANY L I Er I TER ....... D ..... . ... ...... . UT.ICA-M.U.T.P.A.L ....... ....... .... IN.S.-.C.0 ....... .. ... ... ........................................ ....................... COMPANY E LffrrER ... .......... . . ....... . ..... THIS Is To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY ... PAID . C : L . Al MS .......................................... I ................................... ........... ............. . ............. . —... .... ............... .. .............. 11, .......... I ................ ........................ – ............... : i p:w=::p*Ljcv zxpmwcm� om TIME OF MURANCE POLICY miumm ADAM MMMD CPP 2335249 9/01/98 9/ 01 / 9 9 GENERAL AGGREGATE ................... .............. . ...... PRODUCTSCOMp/OP Am X COMMERCIAL GENERAL LIABILITY................................. ....... S f..0 0 0.1.0 0 0 .......... I ........... .......... PERSONAL A ADV, INJURY CLAIMS MADE: X OCCUR.;: .............. I ..... . . .............. 811. ....... 6"CA'S A CONTRACTOR'S PROT.: EACH OCCURRENCE ........... ........ ...................................... 0 0.0.,..qo 0 ...... . ...... ......... ARE DAMAGE Vily.Oft "g.....0.1 5 660 .................. ...... ................. ...... .................... ... . ........ ....... ...... mEo. upone tAny am vemn): & _900 AUT011110031Z LIABILITT 2335250 9/01/98 9/01/99 COMBINED SINGLE ......... LIMIT...... ANY AUTO .... ......... ALL OWNED AUTOS BODILY INJURY (per P-) X SCHEDULED ALIT08 ......... ..... ....... ........ ............. ....................... HIRED AUTOS BODILY KIM (Per RcQww* $ NON -OWNED AUTOS ............................. ................................. GARAGE LIABILITY PROPERTY DAMAGS .......... 5 9/01/98 9/01/99 EACH OCCURRENCE MtCM LIANUTY 2335251 ......... .......... - ........... ....... ...... -- ------ AGGREGATE tsi.COO. 000 mscmpmm OF 61PERATIONSILDCATI0NafflMCLK"PECIAL =go TOTAL P.02 APR -29-1999 08 34 ATTENTION: John Evans COMPANY: Morton FROM: Clarence Levesque DATE: 4/29/99 RE: Morton N Andover i DRYWALL L DEMO CONTRACIOR PROPOSAL NO. OF PAGES: 1 P.01 FAX #; COMMENTS : Demo: Existing space, remove all vct remove two toilet rooms, remove demising wall. All debris into W.U. dum sten. New work: Metal stud fimming and gwb W/ 3 1/2" insulation at new offices. Install new ceiling to match existing at new office, re�lase tiles at front new office. F.I. ( 9 ) new doors and frames. - Total $ 14,050.00 Alt: to remove cTpet $ 2,000.00 call Clarence HAVE A NICE DAY! (978) 851-9820 - FAX (978) 640-0716 TOTAL P.01 0510541999 11:43 7819335645 mow. GEATIFIW PRODUCER D*Sanct!B Insurance Agcy, Inc, Ten Walnut Hill park Woburn Mme► 01801 DESANCTIS INSURANCE PAGE 01 OF LIABILITY INURMG DATE(MMODFn') THISCERTIFICAT IS ISSUED A q R �I 05 03 9S ONLY AND CONFERS NO RIGHTS UN THE CERTIFICATION PO HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Morton International Morton International Attn: John Evans 60 Willow Street No. Andover Mm► 01045 A�iitD �5.9;`(1A4a . ;. M ORTN-2 e+MW AMI OF TME ABOVE oc&mo m pa -c m ae CANCELLED OOKM THE ETHEM TIS, eUI��LT G COIO MAROA rtTB1 NOTCE TO TFETORE LEFAR NOTICE &NIMPoR LLLBRm ANY rQ oft COMPANIES AFFORDING COVERAGE phwmmo. 781-995-84 F�r1o. 1-9 -564 aalREo coMVANY A CNAinpuranoe Companies COMPANY e The Hartford Wall* Unlimited, Inc. COMPANY C 1500 Shapaheen Street TewkaburY HA 01876 COMPANY 0 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWrrHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE WITH RESPECT TO W81CM THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. OR TWE OF INSURANCE POLICY NUMBER POLICY EFFW IIVE POLICY EXPIRATION DATE MA4D&M DATE p/Ml WM LIMITS GENERAL LIAIULRY i A X COMMERCIAL Gf:NERAI IIAeRm 1069220110 09/15/98 GENERAL AOORWATE 09/15/99 PROoucm-OOMPmPAGO 12 000 000 CLANS MADE N1 OCCUa � 2 000,000 OWNER'S A CONTRACTOWS PAW �RBO IAL A AOV IN,AIRY 81,000,000 EACHOOCUAW"m 11 000 000 FIRE OAMAGE (Any &w w,„) $ 100 000 AUTOMOBILE LIABILITY MW EW mmv $20,000 ANY AUTO 013206 09/26/98 09/26/99 ODWNEDM+OLEUMIT ALL OWNED AUTOS $ SCHEDULED AUTOS SO100-14 $500,000 � WNW ALIT08 x NON -OWNED AL11O6 BODIL ftAIRY$500,000 PROPaeTY DAMACE s 500 , 000 GARAGE LIABILITY ANY ALRO MRO ONLY • EA ALICICIPIT S OTHER THAN AUTO ONLY: QACN AOID@1r • E7tCE83 UABRIIY AGGREGATE A 7C UMartaLLAFOItM 8156951925 09/13/98 EACH OCC 09/13/99 A00RWATE $2,000,000 OINIER THAN UMBRELLA FORM v2 000 000 WORKERS COMPENSATION AND f EMPLOYER& UA81U Y SON 111E PROPI111011m PARTNER3WMCLMW OC' NOT plwnDED EL EACH ACCIDEW I oPACEIS ARE; EXCL BY THI S AQ=CY EL OISFAW • P UCC L"r f OTHER EMPLOYEE 01SEJ►8E . EA EMPLOYEE : Morton International Morton International Attn: John Evans 60 Willow Street No. Andover Mm► 01045 A�iitD �5.9;`(1A4a . ;. M ORTN-2 e+MW AMI OF TME ABOVE oc&mo m pa -c m ae CANCELLED OOKM THE ETHEM TIS, eUI��LT G COIO MAROA rtTB1 NOTCE TO TFETORE LEFAR NOTICE &NIMPoR LLLBRm ANY rQ oft From: JAMES P. ERRICOLO To: JOHN EVANS TO: JOHN EVANS FROM: JIM ERRICOLO DATE: May 3, 1999 Date: 5/3/99 Time: 2:56:10 PM MECIIANICAL, CORP FACSIMILE TRANSMITTAL --------------------- REFERENCE: OFFICE EXPANSION COMMENTS: # 371 OUR QUOTE FOR THE SPRINKLER WORK AS PER OFFICE LAYOUT DRAWING (20) HEADS IS FOR THE SUM OF ......$ 3500.00 DOLLARS OUR QUOTE FOR THE PLUMBING DEMO OF THE EXISTING BATHROOMS IS FOR THE SUM OF ............................ $ 600.00 DOLLARS TOTAL QUOTE $ 4,100.00 DOLLARS NUMBER OF PAGES 1 (INCLUDING TRANSMITTAL) ALL PAGES TRANSMITTED WILL BE CONSIDERED RECEIVED UNLESS NOTIFIED -------- OUR FAX NUMBER (978) 794-4364 J 8. E MECHANICAL COF2P PLUMBINGHEATING_4C F1 -'TING P_O_ SOX 5'17 22 ANNIS ST" � M ETH U E N, MASS O 1 ��." 97888-3203 Page 1 of 1 INSURED J & E Mechanical Corp. P.O. Box 517 Methuen, MA 01844 DATE (MM/DD/YY) 3/19/96 ' COMPANY A Aetna Casualty & Surety Company COMPANY B COMPANY COMPANY D 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. IO i TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVEATE (MMIDD/YY) I POATE (MM/D OLICY ADIYY)N i LIMITS GENERAL LIABILITY 1 GENERAL AGGREGATE $ 2 UUU UUU A COMMERCIAL GENERAL LIABILITY 006025333083 1 1 /1 /95 11 /1 /96 I PRODUCTS - COMP/OPAGG $ 2,000,000 CLAIMS MADE OCCUR PERSONAL 8 ADV INJURY $ 1 000,000 OWNER'S & CONTRACTOR'S PROT { EACH OCCURRENCE $ 1:000,000 FIRE DAMAGE (Any one (ire) $ 100,000 I MED EXP (Any one person) $ S _ no() A AUTOMOBILE LIABILITY ANY AUTOCOMBINED ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS((�H) 006FJ0025333083TCA 006FJ0025251144TC ll/l/95 11/1/95 1 SINGLE LIMIT i BODILY INJURY I (Per person) 11/1/96 1 BODILY INJURY ll/l/96 ' (Per accident) j PROPERTY DAMAGE $ $ 500.000 y $ 500,000 $ loo,c)(g) GARAGE LIABILITY ANY AUTO l AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY. EACH ACCIDENT AGGREGATE $ " $ I$ AUMBRELLA EXCESS LIABILITY FORM OTHER THAN UMBRELLA FORM 006X S25333083 I i EACH OCCURRENCE 11/1/15 1 1 /1/96( AGGREGATE 1�$ _f5.QQT_QQQ is - i $ A WORKERS COMPENSATION AND EYPIOYERS' LU►BILlTYEL OktA) THE PROPRIETOR/ I INCL PARTNERSIEXECUTIVE OFFICERS ARE: j EXCLj 006CO025333083 a (*Ten days notice Of dance WC STATU- I OTH cTH TORY LIMITS ER EACH ACCIDENT $ () 11/1/95' ll/l/96 EL DISEASE - POLICY LIMIT $ 1 1 at i oh applies) 5(10. 000 EL DISEASE - EA EMPLOYEE . $ Cnn nnn OTHER 1 I � I DESCRIPTION OF OPERATIOILS&OCATIONMEHK LESISPECIAL ITEMS Various projects as specified in Massachusetts Morton International 60 Willow STreet N. Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED IOUCIES BE CANCELLED BEFORE THE EXPIRATK)N DATE THEREOF, THE ISS G COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO E CERTIFICATE HOLDER NAMED TO THE LEFT, B FAILURE TO MAIL SUCH NO E SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDS UPON THE C PANY, ITS AGENTS OR REPRESENTATIVES. a !O #•♦ TOw Z O O n '41 US0 t 0 c co Vo n 0 D m Q a %C n c r n n = ( w m > > o - m z mcl)3 � -D t O m m m O �1 > > m 3 -v 00 CD m �h m 3 w y -n n o _ �/ m 2 0 Co CD CL .. 69 rfl 69 69 69 69 D m coz y v o N o CO)( (/� < L, H0 �, 0 0 U) 1-4 O K rt C a m n t� C) a o 0 a H• H O R n r* to H o C a cn 171 rn m cn N H. 1-+ r� r* O C�7 rr i17 O C r -i, r•r �..r H m a rt (D O c n H m C b n Qo m O r• •� •1' 0 w tH. r• m op �. 0 m C- p� c•r 1--� r � H • r• m m r n m z t r• C O rr rr, rJ rt (� rn ° m w m C C o H n {i r. y m 'c cn C m rC � rt c* •{�/ O O C n r. •� r,. Fj. rY, o o U) A 7 Z R.\ 0 Alt A ►Q t. mo, Stc Sxa cFF P�c. SEP 2 a ioo.i (toz SIGN PERMIT APPLICATION w NORTH ANDOVER BUILDING DEPARTMENT Division of Planning & Community Development J 1 8. Illumination: (a) Not illuminated (b) Internally illuminated ( ) (c) Illuminated from separate service ( ) 9. Proposed Colors: Background Lettering MIFF P�(ue / Q1.E 14ck Border No \01 T 10. Will sign overhang any public road or walkway: Yes ( ) No (X) 11. If Yes, Name of Agency who will provide liability insurance: 12. Attachments: ( �) -;Photographs of building ( �/) Material sample ( (/� Color samples + ( (/) Site or Plot Plan (Required for all free-standing signs) ( (� *Drawings of proposed sign ( ) Other, specify 13. Is Board of Appeals decision required? Yes ( ) No ( ) Signature of Applicant %(O'C'. �,)JA2 WtOt to 9(ql- ''V (8 1988 -rWo f3frec1r0Kcr(-)(9V'5 30Jrx30rf Date Filed: 1. Site Address -6^0 W (%Uk) .91 2. Owner Nlor4yy, 1 o4x-_ 'oor oo,,\c( 3. Applicant M9.1CIS _ C21A1 S _ . _ . _ 17864 C�1�1(M�T S «�(S 4. Number of Signs Size of Sign(s ) 2/ 3O"X 3d�' — tZS'SFta�4 5. Site of Proposed Sign(s) e522 6. Materials: �jUwt1 tnUy� iJo�� �JC�ff01�� S(C(ln ��(Sfietn� 7. How attached: (a) Against the wall ( ) (b) Roof ( ) (c) Ground (I�" (d) Other ( ) 8. Illumination: (a) Not illuminated (b) Internally illuminated ( ) (c) Illuminated from separate service ( ) 9. Proposed Colors: Background Lettering MIFF P�(ue / Q1.E 14ck Border No \01 T 10. Will sign overhang any public road or walkway: Yes ( ) No (X) 11. If Yes, Name of Agency who will provide liability insurance: 12. Attachments: ( �) -;Photographs of building ( �/) Material sample ( (/� Color samples + ( (/) Site or Plot Plan (Required for all free-standing signs) ( (� *Drawings of proposed sign ( ) Other, specify 13. Is Board of Appeals decision required? Yes ( ) No ( ) Signature of Applicant %(O'C'. �,)JA2 WtOt to 9(ql- ''V (8 1988 -rWo f3frec1r0Kcr(-)(9V'5 30Jrx30rf ZG '0' G" :a=7alcOil -i Vsiinrs F Em*Yees E shyer <=.Aff DeUveries F Dutton &Game/d, Inc 30 �K si c�'w i r•5ta-tt-eot Wear i vote.. P- u te to t KS-k,�,Uahb►. o�ra.w��Kq 30.. � i � to met cert •F� meq? S f � v'S� �c Fotw•a►'!' Smith 3. 40 tum pwaiH S 141A Hr L ILS � ;Q Hr L N2 )- l i Date.//.... 9 TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING 8 A This certifies that ....:..- �.:...._ ......f-;? J Q has permission to perform ....�..'.....:. �:..:.::...:..:*....�...-.... -^.................-.�.*.. wiring in the building of ...........: �7' y- `- at 't-^-" -!-/ .................. . North Andover, Mass. ..� Fee'(�d.. ..... Lic. No.......... ....... ;fir-P�....................... ELECTRICAL INSPECTOR 1 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7hF09W0NWF.4LTH0FARMCY USE77S Office Use only DEPARTAIENTOFPIIBLICS-4FM Permit No. / 6 J?,/ BOARD 0FFIREPREVLV70NREGLE4TI0ASR7CW 12-00 ' Occupancy &Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location (Street & Number) Owner or Tenant i4,t D yti7;� A,/ - w7FT /t►,y,q /��,u N f Owner's Address ,S'/4 �( Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) Purpose of Building /F7- /� Utility Authorization No. Existing Service Amps / Volts Overhead Underground M No. of Meters New Service Amps / Volts Overhead Underground r --J No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work - x17e A�- ! 7777– 7A g, No. of' lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No.o f Lighting Fixtures Swimming Pool Above Below Generators KVA L 7 Qground round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total7 / Tons /� J No. of Detection and No. of Disposals No. of Heat Total Total Pu os Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP 16 aL OTHER– hIM=COAr• •• i :. u: ..� • .�... •:1: YES lha%eaftne2dvabdprCOfOfSW&lDtheOffim YES • • - • :• :• •Vo i a•- box �u :• c Ci:•1 v. •rFIRM NAME i fJ Sigr== �/���� �/ / ii�✓� /f���'��` Bus¢m Tel Na �C� Alt TeL Na, :' f Z– �j% G OWNER'S RgSURANCEWAIVER, Iammm hitrLi=edoes�thert>suaneoAeaWcrgss xb tral asm*xcdby Ga>aalLmvs and fat my sig>a�eon � p� app8cation waw this t�v�d. (Please check one) Owner M Agent Telephone No. PERMIT FEE $ %� � 1Z1 OD Ttall Z 9£ ; VA - 1 1 tttltt..t.,.!!!'Iw!i►51tt1,w��E c �, LtiB 2 i ny. 1 SCA :a-�4 Tb r A % v �Y� z*c — _ y y tic° O •,\ Via, / �' `, o o y y�. .M. o'v BulidinQ Location l Gvt 11 Permit k �% .. Owner's Name New ❑ Renovation ReplacernerA ❑ Plans Submftted: Yes . p No W twit ~ o „ ~ � a W ►o- u e~ H z w C ss et sc o o60 a o= e a: y= U _� = N►- e C c.11 ,�� l J~2 riOW < sr c f' fir- O L ry1 J a D t. p V a > o a F O sufs—tawT. eAeRM*MT taT FLOOR !NO FLOOR l 3RD FLOOR iTHFLOOR STH FLOOR STH FLOOR TTH FLOOR I STH FLOOR.I ±T Installing Company Name J (; �(-V,-e , Address �.L 0 .� , Cck one: Cedlicate Corp. 0 d Partnership --+— Bwlness Telephone q 1 k– 3- 0 7 — ❑ Flrm/Co. _ c Nurse of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability Insurance policy or Me substantial equivalent. YIe`ck o K you have checked, ►e:. please Indicate the type coverage by checkingthea No ❑ pproprtale box. A liability insurance policy ❑ Other type of Indemnity ® Borxf ❑ OWNER'S INSURANCE WAIVER: I am aware that the Ilcenaee doetF Lc have the Insurance coverage required b Chapter 142 of the Mass. General Laws,.and that my signature on Ihla PermR application waives INS requiremenL y Check one: W"twe of Owner or ownet's ^wall& Owner ❑ Agent 0 I haraby certify that all of the details and Inlormallon I have submitted for anlered) In above Application ars true and eocurate to knftiedpe end that all plumbing wort: and Instaliallons pedormed under the permil Issued lot this appUcatiOn will be In Uw best of my provisions of the Massachusells er Seale Gas Code and Chaplet 142 0l the Genal Laws, �plance wllh as T " ns4: t>!ie uber seller a r^a ° n um of or as ar pylTgrrrt aster nse Number Joumeymen N"Mo (orrICE USE oNLy) r_? 1 0 J Date. "ORT" TOWN OF NORTH ANDOVER pa+ „ao ,+,tiOL p PERMIT FOR GAS INSTALLATION o This certifies that:. has permission for gas installation ............................ in the buildings of ............... ............�. at .. A -Z ..l!'� J.. <.' , . �(- .... , North Andover, Mats. 7 1� GAS INSPECTOR N WH E: Applicant CANARY: Building Dept. PINK: Treasurer ulle OtI11tmnnluenitll of _410000111t(netts 8rpnrtmrnt of �uttlic �nfrt� BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 Office Use Only Permit No. Occupancy A Fee Checked _ 3/90 (leave blank) %e APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ` All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Lor of Wires: ( c Qlw or Town o _ _ �� i� To the Inspe Vlt� Qt„tQl� — -- The udarsigned applies for a permit to perform the electrical work described below. Location (Street & Numb �er) 60 y� Owner or Tenant 01:to VA �N` it1 ------------------- ---- =---- ---- Owner's Address Is this pettnit In conjunction with a building perrnit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Z7x(c,S-f RJ- - l Utility Authorization No. Existing Service Amps __I Volts Overhead ❑ Undgrnd❑ No. of (vleters New Service Amps _J Volts Overhead ❑ Undgrnd U No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work(� f t�t-frig-el A Llk n me -d No. of Lighting Outlets --_.�.......----p-rt---_-- No. of Hot Tubs 7 - -.. I - - . o la I No. of Transformers TKVA ---_ _ — No. 01 Lighting Fixtures (- • Swimming Pool AboveIn grnd. ❑ grnd. ❑ Generators KVA — No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARtitS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initlattng Devices No. No. of Disposals No.ol (lest Total Total Pumps Tons KW of Sounding Devices No. of Sell Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal ❑Other ❑ No. of Dryers Heating Devices KW Connection No. of INo. of _ Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Ttlbs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES NO r- 1 have submitted valid proof of same to the Office. YES NO C 11 you have checked YES, please indicate lire type of coverage by checking the ep opriate 13ON box, �� / � INSURANCE � BOND C OTHER G (Please Specify) / Jfs�ti.-�/L, (E irstion Date) Estlmsled Value of EI ctrlcal Work S ��=Jj� Work to Slott _ 7 _ Inspection Dale Requested-. Rough r—% 4;__ Final Signed under the att(04 of perjury: FIRM NAME Itir UC. tJO. Licensee Signature C. NO._� Address d ADX 626 ��,e S}p f� ( ^' Bus. Tel. No. g —�—[,'—�-V 93 Alt. Tel. No. OWNER'S INSURANCE WAIVER-. 1 am aware that the Licensee does not have the insbrance coverage or Its substantial equivalent as re• quired by Massachusetts General Laws, and that my signature on this permit apptication waives this requitement. Owner % Agent �(Please check one) Telephone No. PERMIT FEE S Date......r ..............,l.4 044 t , TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ................ t.................................! L.........................:.... has permission to perform ......`,....................!.k............................................. wiring in the building of ........ :.................... at ...............`.............:................................................ , North Andover, Mass. .�..,.:,1... Lic. No. /...:.:..f �.:............................................................ ELECTRICAL INSPECTOR r-'A-07/&4§5'1rjg 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION-FORPERMIT.TO:DO--PLU 14 (Type or Print) ;; :,i:.•r• ; Ni ;N� ` NORTH ANDOVER ,Mass. :�-<,•r%'.. Date:'1�/% Building Location �0 Gvf//ops �S'f I�' Permit I ,Y Owners Name til alai V New Renovation Replacement Plans Sybmitted "�C F T U F i, ' z � i or I' • to = x < !n o z a < N z 4a -C cc Q W t•• Y! P .. I . Q x Q al J A Ul a = ¢ �'_ < W of M a (� = Q O In W Q N O a rn = Ac 0.� tt W t- 1- W < 0 tr a "s O O 6. tK � W x< Y O x 7C. It a O !- < X< to tc X l'- O a f � N� z o Q 0 x x w t•' o 0 3 3 J t0 m a O J = t- o) 0. co 7 O t 'ac a 0 SUB—%BSMT. • BASEMENT 1ST FLOOR �'J tai ti t - 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTH FLOOR ' 8TH FLOOR (Print or Type) .� r Check one: Certificate Installing Company Name 1� ke- (,Ar.,-/C¢L Corp. f6 d T -G Address ��� `� a ,e S`-(2 Partner. ye-✓ ®/� Cj Firm/Co.� Business Telephone 9 7g Name of Licensed Plumber: 6cxi Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 1�j Other type of indemnity [:] Bond Li Insurance Waiver: I, the undersigned, have been made aware - that the licensee of this application does not have any one of the above three insurance coverages. • Signature of owner/agent of property Owner AgeneN (� 1 bereby certify that all of doe details and infotmalion I lumn vc subunillcd (or emceed) in atwe appliaut lioe ice loand crtrat* to Wt bat r of I..• - kmwkdge and that all plumbing work and inslaltalions loctfntnicd undct retuiit itsucd fat Wis applicaliow wiU be in cotupWowa with allvall" t OW10 tido" of dw Ilataebwettt Stale Plumbing Code and Quplet 142 of the (knual t,.L �w 8y ' i • iTitle • 'gnature of'Licensed Plumber City/Town: �,7 Pe of Plumbing License I - Za - • --- rn Date q; TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 8 �SSACNUSE• This certifies that ............ ....... . ....... . t has permission to performr.. .............. ...... !.. T �'"'� . plumbing in the buildings o ... .. ........ � at . ...... , North Andover, Mass. Fe/A" . o" . Lic. NoYfpF .. ............................. . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer x MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING � (Print or Type) l NORTH ANDOVER Mass. Date - .3 4uilding Location 4� ly� l/�,,, S Permit %Y6 f Owners NameA# ' Y _ New 2.1" Renovation U] Replacement Plans Submitted l] XTI I . '-- c (Print or Type) Check one: Certificate Installing Company Name c,//v���y( d Corp. /Ga 7- c Address ,%Z 0- 13. Partner. D!fi/o Firm/Co. Business Telephone: ' Sad - 3303 l Name of Licensed Plumber or Gas Fitter y� e f �. 2'< L,,Zo Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent Q I hereby certify that all of the details and information I hare submitted (or entered) in above application are true and accurate to the best of my knowledge and that aU plumbinr work and Installations performed under Permit isseed for this application wiil_be !n compliance with all pertinent provisions of the Massachusetts State Car Cade and Clupter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE use ONLY) YPE LICENSE:. Plumber sfitter lbiignature of Licensed Master Plumber or Gasfitter Journeyman yX 79 License Number MISS EMENESIME �ii�iiENiiiiiiiiiimiiiii ENNEENNEWEREME MEN (Print or Type) Check one: Certificate Installing Company Name c,//v���y( d Corp. /Ga 7- c Address ,%Z 0- 13. Partner. D!fi/o Firm/Co. Business Telephone: ' Sad - 3303 l Name of Licensed Plumber or Gas Fitter y� e f �. 2'< L,,Zo Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent Q I hereby certify that all of the details and information I hare submitted (or entered) in above application are true and accurate to the best of my knowledge and that aU plumbinr work and Installations performed under Permit isseed for this application wiil_be !n compliance with all pertinent provisions of the Massachusetts State Car Cade and Clupter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE use ONLY) YPE LICENSE:. Plumber sfitter lbiignature of Licensed Master Plumber or Gasfitter Journeyman yX 79 License Number Date ..................... TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION s 'I This certifies that ...� ... ............ r ....................... has permission for gas installation ............................. in the buildings of .......................................... at ................................ .. , North Andover, Mass. Fee J.. "...... Lic. No........... ... I ............... f GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File 0 0 o� w -a p .s' m 0 c° m *** TOw w 1i\R Da R;?� • a 0 0 0 o� w -a v 0 S1� CD I p m 0 c° m w Da a 0 r ^1 l J CDD N CD 0 > 0 > 3 o C Z > 00 > M '' = co 3 0 0 _— C -n 0 m 3 ^� -v C 00 C Z -n CD -n CD CCD CCD " 7 co �T (CD i a 69 69 69 69 69 69 69 Z N4 o CD � � o c v 0 S1� CD I 0 ,lr > > m m m N + O r �I = r r a O C i a n n j -1 z z a a N w .� ...� � ..r r -. .... . . � .r eW .. '\.;'.1 Y,: fes. '. N', 1• .1 .y t� AO v W m f G �, > o o o P, d A 0 o r N; Q Q a > j.I j y r = Z Z n Z A 4- C C A m 0 m r r r O Z Z Z g A a L O C O O O 'q n Inn m A n a a 0 O > L1 L1 O -4 O A m Z 01 O > ZI o G o0 O 0 0 0 zi Z A m +8lQS� 19n r 0 m m m > m o = A a 0 A O W 0 z w 0 0 a Z i •-pi i c7 � > i (� •z'1 m m a+ 0 r 7° > m A n m i n r � ac r ac m; A i n 00p n n j Q O tD 0 i m S r+ — c O z O a O `� ? 0 -< (D 0 o 0 ro W InZ W -4 Q •� � p CS Cl O � { '= 0 > Z -o, 0 \ O O o (21 C N N 07 W m � m f q �, > o o o m> o o r N; r > j.I j y r = Z Z n Z A C_ C C A m 0 m r r r O Z Z Z IOn A a L O C O O O 'q n Inn m A n a a 0 O > L1 L1 O -4 O A m Z 01 O > ZI O 3 3 zi Z A m t0 19n r 0 m m m > m o 0 ' a 0 A O W 0 1 A M a Z v z > i m a+ 0 z r - j p O tD Z i m S r+ — c z O a O `� ? 0 -< (D 0 o 0 ro W InZ W -4 m N 0 0 > -o, 0 u, rr C N N 07 ro ro m - r0� + -' m - cn Q rr -1 CO z O D— Z ro 3 0 I O. - w - + a o x+ O lOn z 4 z Z O � m ro O V - � V + h a a m m N m o 9 a N m z O 9 N m m m m m n m z m In A y c c C = zO z 0 P 0 O a In m n °o o 1 1 n 0 czi czi czi 0 r i „ O w O 0 A m m n n n O n z 0, A a umi m c_ o Z Z Z a = a C O 9 a -� > r O mmmrZ >O0r mm�2 0 O m a" A z 0 m 0 m 0 m 0 0 Z H a Z 0 O O A „ + O m r •F a I it �'' a N i l i o I n 2 A z z r uroi r m> >- 0 N m r m -G o = sn o m t QN Z I Z oO n V In - a o O i °° w -+, p o0 i 0 A 0 b X11 f N > m � DEPARMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE y Naber, ,Expires: BirChdae: f, CS t�Pfi900 95l24/1%9 9512411946" Restricted To: 00 s - MICi!AEL A LUONGO x`tj .�✓° 32 Ft,AULKNER HILL RD , aL. s ' KA 9026 FORM U,- LOT. RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and_^ partments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ********* *****APPLICANT°FILLS OUT THIS SECTION APPLICANT (D144n 57L 8U/Lb)A)6 c0.q�8 4 =NG'. PHONE 65-7 -7 3 oo LOCATION: Assessor's Map Number 9S D PARCEL 0 6 SUBDIVISION l - A J D o J I= R B05140,'9 TPrg K LOT (S) 18 STREET W )LL -d W S-7 • ST. NUMBER (00 RECOMMENDATI( ICTAL USE ONLY Of TOWN AGENTS: CONSERVATION ADMINIMNATOR DATE APPROVED DATE REJECTED COMMENTS / m A .�-• �Iti S G�y1[ Mit . TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS ��' Q� Q A I L A/-) FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS 4 PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPAJjT NTTeUyeo 0F21fiv^2«Tit-_e�• 01d-S�(l�c�s/fin d;��1Z1Srl'N4!-L /Z/l7 RECEIVED BY BUILDING I R DATE__1' / $ OFFICE OF BUILDING INSPEC'1.OR .• T014N OF NOR1'll ANDOVER CONSTRUCTION CONTROL ': %,.' PROJECT NUHBERs PROJECT TITLE: der vn Zh PROJECT LOCATION:_649 Q IAA f W024_� 9514� NAME OF BUILDING: Mo✓4n NATURE OF PROJECT s L.ab-,�?�1� IN ACCORDANCE. H SECTION 121.0 OF THE MASSACHUSETTS STATE BUILDING BODE, I' 0'i9 Registration No. __4757 BEING A REGISTERED PROFESS AL ENGINEER/ARCHITECT HEREBY CERTIFY THAT 1,11AVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICA— TIONS CONCERNING: ENTIRE PROJECT (] ARCHITECTURAL Q STRUCIURAL Q IJECHA1IICAL Q FIRE PROTECTION Q ELECTRICAL Q OTHER (specify)Q FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF RY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND- SPECIFICATIONS MEET THE'APPLICABLE PROVISIONS OF THE MASSACHUSEITS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES. ",AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY FROFESSIOIIAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETER11INE T1iAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN ,SECTION 121.2.2: 1. Review of shop drawings, samples and other sulx,•3ttals of the contractor as required by be construction contract docunents as subndtted for building permit, and approval for conformac►ce to the design concept. 2. Review and approval of the quality control procedures for all code—required controlled materials. 3. Special architectural or engineering professicnalAnspection of critical construction comrpenents requiring controlled materials or eonstructicn specified in the accepted engineering practice standards listed in Appendix B. PURSUANT TO SECTION 127.2.31 I SHALL SUBMIT WCL• KLY , A PROGRESS REPORT TOGEIIIER WITH PERTINENT COMMENTS TO THE NORM ANDUVE1: BUILDING INSPECTOR. �EREp AR, �g Bo USC UPON COMPLETION OF THE WORK, I SHALL SUBMIT A F111AL REP T AS TO T COMPLETION kND READINESS OF THE PROJECT FOR OCCUPANCY. BOXXFnORRD, S 1 GNAT UREl „yS SUBSCRIBED AND SWORN TO BEFORE HE THIS _DAY OF I PQ19_CLL of , o,-C i Q 4X1 m. Mcg L" - (�(� NOTARY PUBLIC Hy COHM1SS1011 EX1'1RES ` `� �0, IT C c "01 d x N o Q CA CI �:O O - y d S CD m T Z — m ?'fl a. = of m � d = y C •� o -�ooy o p = =aca m2-101 c N ;,n (s oZ a'. o o•o .G L- C4) F6 3310 5.0 C. c� m g 9 s �A ®r. d d p C/) o c�'v' c C� a� y O � 3o _ o r. y rf y d?: Q t. CD C p H � < to G.� p i' ? y m� o C y mD cr m %4c CPDIOI rn co CD p CD W �, Z O W o c, c° Cn Z :a CD y C. y o co g �.. ^' i aCD Aw y p Cn �y o CD i S7 a CD :4 C -p CDCD �� ons: 0 CD "0 ; �? = m H 0 0 c ^f� 7d :7 y� ro b 0 C rA rA � 0 :J r CLOil CO) cn g O H 0 0 c CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number. / ?WOW THIS CERTIFIES THAT THE BUILDING LOCATED ON_ _ (v I MAY BE OCCUPIED AS Date 7/7/?M, / I IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS O Fmo ol 0 J mcc SO O $ nc -� a CF CD.� WW''W L 1F- ' y o o, 2: N A o .- �'! o 3 C C � m W C m m0 cT-ac O Q c� y W O C C "• �... •444 C36= A LU W ca CD CD O CA) a 09m� z= .0y F- z s a. m g O 6 O ^T C3 o � w CD a c� O 4c\ N a ' �- xV. z Q � y C o CD C C � Q a CD CO) o �' m m a � •a v o o� � a o � W o u '� � � z� � o u• w U w Q � ; ol 0 J mcc SO O $ nc -� a CF CD.� WW''W L 1F- ' y o o, 2: N A o .- �'! o 3 C C � m W C m m0 cT-ac O Q c� y W O C C "• �... •444 C36= A LU W ca CD CD O CA) a 09m� z= .0y F- z s a. m g O 6 O ^T C3 o 0 N CD L Q N C Z Q, Q � y C I CD C C CO) Q CD CO) — Co '2 m m CD CL 0 CD Q Q � ; ccoQ L m Q Q CL cmQ CO) � �cc °o Q .0 CL •v CD Q sCD `�o v Z {{•0 ?f Q CL Q i � C • C •y r- k- rrl William J. Scott Director TOWN OF NORTH ANDOVER OFFICE OF CUNINiLJNI't'1' I)1:�'l:Lt)1'1lI:N'1':1NU SERVICES 30 SCHOOL STREET NORTH aNDO\IEK, NIaSS?►CHUSETTS 01845 CONTROL CONSTRUCTION - SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTUR>ti BUILDING INSPECTOR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER MA 01845 Telcphone (979) 689-9531 FAX (978) 688-9542 GENTLEMEN: 1, Jame c Bo ggn,_aR A _, HEREBY CERTIFY THAT THE Morton International, Inc. BUILDING CONSTRUCTED AT6 0 Willow Street DOES CONFORM M ALL RESPECTS TOTHE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGUALTIONS FOR THE FOLLOWING: AUTHORIZED SIGNATURE: James Bourgeois, R DATE: 60J, $ REGISTRATION: #4757 NOTE: ENGINEER "WET STAMP" MUST BE AFFIXED TO THIS FORM 'RED A��y� S�5 gO lj j AVb X57 MASL � rd� BOARD OF APPEALS 6XH-9541 Cjl.l1l,DjNC1, ,-%'4_v5;i CONSERVATION fixe 9531) HEALTH 6138--9540 PLANNING 6813-95315 146 MAIN ST. 1'0 hIAIN ST. ; 30 SCHOOL ST. ii 5C'tICX)l. ST. 30 SCHOOL ST_ r, J June 30, 1998 Henry R Torpey Torpey Engineering Inc. 20 Parlee Road ,CAVdr1sf0rd, fM 01824 James Bourgeois, R.A. 477 Boston Street, Suite 12 Topsfield, MA 01983 Channel Building Company, Inc. 355 Middlesex Avenue Wilmington, MA 01687 Re: Morton International Building Alterations Metal Organics laboratory Expansion 60 Willow St., North Andover, MA Dear Sir. I certify that to the best of my knowledge, information, and belief the electrical installations have been designed, constructed, and inspected in a manner that is in accordance with the latest edition of the Massachusetts State Building Code and all other pertinent laws and ordinances. Xly, O/Y Henry R. Torpey President PM ■ 20 Speen Street, Framingham, MA 01701 TEL 508-875-2121 FAX 508-879-3291 Engineering Planning and Management, Inc. EMAIL epm@epm-inc.com June 24, 1998 F1179 Mr. James Bourgeois, R. A. 447 Boston Street, Suite 12 Topsfield, MA 01983 Channel Building Company, Inc. 355 Middlesex Avenue Wilmington, MA 01887 RE: Morton International Metal Organics Laboratory Expansion 60 Willow Street North Andover, MA Dear Sir: This letter is being sent to inform you that the fire sprinkler system addition in the Metal Organics Laboratory Expansion at Morton International has been designed and installed in general conformance with the approved fire sprinkler construction documents. Sincerely, �„cwoF oy Thomas H. Jutras Jr., PE 7HWAS H. ��, Sr. Fire Protection Engineer Jlll'RAS, JR. FlRE PFtOTECTtON No. 39124 June 2, 1998 RONALD S. FULLER, P.E. Consulting Engineer 3411 N. EI Camino Rinconado Tucson, AZ 85749 JAMES BOURGEOIS, R.A. 447 Boston Street, Suite 12 Topsfield, MA 01983 CHANNEL BUILDING COMPANY, INC 355 Middlesex Avenue Wilmington, MA 01887 RE: MORTON INTERNATIONAL 60 FLAGSHIP DRIVE NORTH ANDOVER, MA Dear Sir: I certify that to the best of my knowledge, information and belief, the structural steel framing and foundation installations have been designed, constructed and inspected in a manner that is in accordance with the. latest edition of the Massachusetts State Building Code and all other pertinent laws and ordinances. Respectfully, RONALD S. FULLER, P.E. (MA #19550) 0 CROSSFIELD ENGINEERING, INC. 65 CENTRAL STREET • GEORGETOWN, MASSACHUSETTS 01833 • (978) 352-6207 • FAX (978) 352-7362 PROFESSIONAL CERTIFICATION FORM FOR REFERENCE ONLY June 9, 1998 Arthur A. Tocci, P.E: Crossfield Engineering, Inc. 65 Central Street Georgetown, MA 01833 Mr. James Bourgeois, R.A. 447 Boston Street, Suite 12 Topsfield, MA 01983 Channel Building Company, Inc. 355 Middlesex Avenue Wilmington, MA 01887 Re: Morton International 60 Willow Street No. Andover, MA Dear Sir: I certify that to the best of my knowledge, information, and belief the HVAC installations have been designed, constructed, and inspected in a manner that is in accordance with the latest edition of the Massachusetts State Building Code and all other pertinent laws and ordinances. Respectfully, By: Arthur A. Tocci, PE, Principal Awam A 1VOd NL" File 0098051 ljl'�4 1 -1 'mal ��N�saaaerr � �-,v� aa•.r s,,, 4. 4L 0 CROSSFIELD ENGINEERING, INC. 65 CENTRAL STREET • GEORGETOWN, MASSACHUSETTS 01833 • (978) 352-6207 • FAX (978) 352-7362 PROFESSIONAL CERTIFICATION FORM FOR REFERENCE ONLY June 9, 1998 Arthur A. Tocci, P.E. Crossfield Engineering, Inc. 65 Central Street Georgetown, MA 0183.3. Mr. James Bourgeois, R.A. 447 Boston Street, Suite 12 Topsfield, MA 01983 Channel Building Company, Inc. 355 Middlesex Avenue Wilmington, MA 01887 Re: -Morton International 60 Willow Street No. Andover, MA Dear Sir: I certify that to the best of my knowledge, information, and belief the * PLUMBING installations have been designed, constructed, and inspected in a manner that is in accordance with the latest edition of the Massachusetts State 'lding Code and all other pertinent laws and ordLnanees. _ ... s Respectfully, NL" 1� 04 atill ' By: Arthur A. Tocci, PE, Principal *This certification applies only to those systems shown on Crossfield Engineering, Inc. Dwg's P-1 thru,P-4 and PP -1 and PP -2 dated 02/09/98. Certification for waste treatment plant shall be by others. File 0098053 �1 JUN-WO-I'Z 2b 1J m 44 1 P1U1'IH5 M. Nr -VC HJJUt-. r . u1 EDC1nc.- mW mmmv (ssoa)887-8586 To Mr.. Ren Surette,• Bldg. Insp. North Andover Bldg. Dept. 120 Main Street North Andover, MA 01845 THE FOLLOWING<•WAS NOTED REPORT s GATE PROJECT NO PROJEcr Morton Intl.. Labs. Exp. t oc t=N 60 willow Str -COWAAC-10HOWNER CBC Morton Intl. W EATH cJ Y) h P A I SI �u r. l�dld�ev Gvo4-s Site • �� z � � y a�fi�•: � t � �! r c .ter-�Y.LJ Eoundations !� Structural Steel masonry P lumbincl Eire Protection J44. S MVAC Electrical t.AV'er to � L Interior Finishes Roof & Exterior Finishes Signed 4757 S WON �J v QF TOTAL P.01 1p 60 Willow Street JOYCE; S 'PA'bi i1AW N9RTMNAN09 ER Waiver of Section 8.3 of the Zoning Bylaw - Site P6 devQv93 The Planning Board herein WAIVES the requirements of Section 8.3 of the North Andover Zoning Bylaw - Site Plan Review. The waiver request was submitted by Gregory G. Welch, Project Coordinator, Channel Building Company, Inc., 366 Middlesex Avenue, Wilmington, MA 01887 for property located at 60 Willow Street. The project involves the relocation of Morton International's Metalorganics operations to 20,000SF of existing vacant space at 60 Willow Street. Extensive interior, mechanical and electrical improvements will be made as well as the construction of windows, doors, and sidewalks. The site is located in the Industrial - 1 Zone. Findings of Fact: 1. A 1,000SF shipping. and chemical storage addition will be constructed with sidewalks, canopy and site improvements. 2. The existing loading dock approaches and an equipment enclosure will be removed. 3. There will not be any significant increase in impervious surface as the additional impervious surface created by the chemical storage area is equivalent to the impervious surface removed with the loading dock approaches and equipment enclosures. 4. The ambient noise level shall be established and the completed facility shale be in accordance with Division of Air Quality Control policy 310 CMR 7.10. 5. No Additional signage is proposed. 6. No outdoor storage or display will be constructed. 7. No proposed landscaping other than loam and seed at former paved approaches and disturbed areas. 8. The existing lighting wi1l_be replaced with shielded wall packs or lights under the canopy. 9. Any revisions to a development that has secured site plan review waiver shall be submitted to the Town Planner for review. If the revisions are determined to be substantial and materially different by the Town Planner, the Town Planner shall direct the applicant to resubmit the site plan to the Planning Board in accordance with the provisions of this section. 10. The applicant has submitted the following plans containing all of the basic requirements of an official site plan: Plan titled: Request for Determination of Applicability Assessors Map 98D - Lot 18 60 Willow Street South Plan titled: Site Grading and Utilities --- Prepared for: Morton International 60 Willow Street North Andover, MA Prepared by: EDC 447 Old Boston Road Topsfield, MA 01983 Date: Dec. 23, 1993 Decision: Given the above Findings of Fact, the Planning Board hereby determines that this project will not have a significant impact, both within the site and in relation to adjacent properties and streets, on pedestrian and vehicular traffic, public services and infrastructure, environmental, unique and historic resources, abutting properties, and community needs. The Planning Board hereby WAIVES the requirement of Site Plan Review. cc. Applicant Assessor Building Inspector Conservation Administrator Consulting Engineer Director of Public Works Engineer File Fire Chief Health Agent Police Chief North Andover, Massachusetts 01845 Prepared for: Cliento Assoc. Ltd. Partnership 355 Middlesex Avenue Wilmington, Massachusetts 01887 Prepared by: MI -IF Design Consultants 12-B Manor Parkway Salem, NH 03079 Scale: 1" = 30' Date: October 21, 1997 Sheet: 1 of 1 Plan titled: Site Grading and Utilities --- Prepared for: Morton International 60 Willow Street North Andover, MA Prepared by: EDC 447 Old Boston Road Topsfield, MA 01983 Date: Dec. 23, 1993 Decision: Given the above Findings of Fact, the Planning Board hereby determines that this project will not have a significant impact, both within the site and in relation to adjacent properties and streets, on pedestrian and vehicular traffic, public services and infrastructure, environmental, unique and historic resources, abutting properties, and community needs. The Planning Board hereby WAIVES the requirement of Site Plan Review. cc. Applicant Assessor Building Inspector Conservation Administrator Consulting Engineer Director of Public Works Engineer File Fire Chief Health Agent Police Chief N Z N S c� w z z L U S< J G =z O J Q w 0 0 W� i > o z w Z >YP ❑ a 0 H z Wgg J a � z— H p o o00 9 3 ly-o£ ;a ati$ H J... n+ CO N n a N Z N S c� w z z L U S< J G =z O J Q w 0 i > o z n F F� ❑ a 0 H z r J O Q Z H _ 2 J 0 N Z N S c� w z z L U S< J G =z O J Q w 0 w C) '� � i r > 4 ° Z a W o 0 < o G J y Z Z w e O ZZ �dQ a =J (fi W J ~ J 2 � O e> O Q e � U 4 Z � w S? J U aiag¢X ��j �5L•� � �� O �g Z w LD s jw Ix€ I I l 'I I I I o s EE sold I �a�� I I o m Od of o O c�F o`ca ca zz ................. :m mao �� L_ �r II m� 1 �ar�: e r� r� r o l rel l r� r� wo LJ LJ L J N LJI LJ LJ LJ LJ LJ o - --- =l= Jig <3 0 iq I 3m z 3m 3U I a 0z Ia6z lamp I ! Iwo of of r1 J LJ LJ L LJ LL� LLJ L o II - I I Q W M �a LJ LJ LJ LJ LJ I I I I —�__ ---_-_ . a ----- ----------------Q oz ERR — - e 0 a e I � I I I 3U I a I W 0- J0-- 00000 -------- ------------ O iz 00000 i`� Ij 4 a - - �l �� C/) _�)G> v0 U OOOO 1 III ilii $ -- - io I I w =l= Jig <3 0 iq I 3m z 3m 3U I a 0z Ia6z lamp I ! Iwo of of r1 J LJ LJ L LJ LL� LLJ L o II - I I Q W M �a LJ LJ LJ LJ LJ I I I I —�__ ---_-_ . a ----- ----------------Q oz ERR — - e 0 a e I � I I I 3U I a I W 9721 D at ee/0. —159 3.. . ..I.d ... .. ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. . .. ....... .. ............ ......................... has permission to perform wiring in the building of ...................................................... at.... .................................. North Andover, Mass. Fee. .�20.—... Lic. No.!�. 392 . . ...... 02 E 1� R1 Check # SDG- �e�M X322-zotl i,ornwon vealth of M7ama��clwetb Official Use Orly �LJePar�men� o�..iire Jervice6 Permit No. � 7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071leave blank APPL=ICATION 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 W INK OR TYfyALLVFj1ATION) Date: &-25,-/o City or Town of: Nd/ h i Ii;P� 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) �j>Q �l(j S-'ee- - Owner or Tenant UOL) C jWn iC A Owner's Address rn b " t I M 0 Telephone No. Is this permit in conjtion with a building permit? Yes V No ❑ (Check Appropriate Box) Purpose of Building To ^%^ A/fe k 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: A //� �� e I. k Completion o the ollowin table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans TransTotal Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above ❑ In- Swimming Pool ❑ grnd. grnd. o. omergencytg mg BatteKy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones. No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat ump um er ons _..._._..........._ .....__...._......_ No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑unicipal , El Other Connection No. of Dryers Heatingfiances Appliances Security Systems:* No. of Devices or Equivalent No. o ater, No. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical. Work: (When required by municipal policy.) Work to Start: // — J— /D Inspections to be requested in accordance with MEC 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 cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE QV BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and a alties of perjury, that the information on this application ' true and con�pleta FIRM NAME: Piquette & Howard Electric r Inc LIC. NO.I4R392 Licensee: Robert B. Howard Signature . LIC. NO.: MR 3 9 2 (1f applicable, enter "exempt" in the license number line.) Bus. Tel. No_ • 6 03 —:5 SZ�:j 18 Address: 222 Plaistow Rd Plaistow, NH 03865 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 a ent Owner/Agent Signature Telephone No. PERMIT I'EL?: $' ' The Commonwealth .of Mass=hmsetis D�;narurent oflndustrial a •^. 14.._tri..nts Dfjice of Invesda adores --' 600 FF"ashine-ton Street Boston, MA 02111 . WWW,. maSS.e o v%did Workers', Compensation Insurance Affidavit: Builders/Contr actors/Ele--tricians/Piumbers AnaIicant Information =Please Print Legibly EiI7e Cs'3usiaasslUeanizatio>ndividual): l Ve�—� ' W �et�� L-�-�l t G s ¢i✓ t� ��-v+ C Ari�-���:_aa� �J•�5�w �o� - ja �1-nl.+/ && 03 S"GSS Phone Are you an employer? Check the appropriate box: Type of project (required): 1.1 1 I am a tanployer with 3 Q • 4. El ,I am L91 -neral contractor and I employees (full and/or part-time).* have hired the sub-contractars 6.. E] .NCW const ucton 2. ❑ I Zan B. sole -proprietor, or partner- listed an the attached sheet 7. ❑. Remodeling ship acid havens employees These sub-contractars have a.17 Demolition •working for me in any!caparary, employees and have workers.' [No workers' comp. insurance comp. insurancc,�: 9• Q Building addition required.) 5. [] We area corporation and•its l OXElectrical repairs or additions 3 • ❑ I am a homeowner doingall work officers have exercised their � 11.7 Plumbing repzirs or additions myself. j1Qo. workers' camp, right of exemption perMGL insurance rrquired,j t C. 152, § 1(4), and. wr, have no 12.j] Roof repairs employees. jNo workers' 13.7 Other comp.. insurance required.) 'Any applicant that cheoks box Al. must also fill out the section below showing their workers' compensation policy information. t iio ..wn :rs who submit this affidavit indicating they art doing all work and:thcn hire outside.cantractors muni. submit a new affidavia irmi sting such; lConttactors that cheol; this box must attached an additional sheet showing the name of the sub-contnmtors and state whether orr not those antics have employ==. If the suircotttractars have =P''oyecs, they must provide their workem' eomp,.policy ntimber.. I am an employer flat is providing workers' r-Ongw radon imarance for my employees Below is the policy drat job site infornsafiori. � ' Insuran= CompanyNmnc: v 4t ;Lns v� .e Policy # or Self-ins.I:ic..#: M W C 9 j09 I Jr- EXpiration Date: Job Site Address: 1 City/5tatslZip��Q�Q Attach a copyofthe workers' compensation policy declaration page (showing the polio3,.number and expiration date). 1 Failu -- To secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminalpmahies a a fine up to 51,500.00 and/or ome-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and .a fine, of up to S25100 a day against the violator. Be, advised that a copy of this stat:.-mcnt may be forwarded to the Offiice of i InvestigrStians of the DIA for insurance coverage verification. t i I do hereby ca* Ste pains and ofPe�rju77that the information provided. above is arae and vrrmt Date: I0 Phone#; 03-3Fsa-3/Ba — 0f l cla:z use ordy. Do not write in this area, to be completed hj, city or town ojTlrlal City. r Town: Permit/Litense # issuirre Authority (circle one 1. Board of Health 2. uiiciine Departrne 3. City/Town Clerk 4. Elecir;cal Inspector S. Plumbinginspe�or 6. Other .: Contact Person: J -2f IMUMT Pbane 617-961-3367 Location No. " n:5 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee -', $ TOTAL $ Check # r r n /2 Building I ector 01 Z m z r O vi X m "v O oa v <-o -0 o d < N 00 �. N• O 7. N N mo' NCDD O 00 � rL `°SCD �a co (A �rL2)_ C � O CD CD � m 0� (A 0'0 o(D CD oCl)� O M o. co 0 (A c ••► .+ N ? 3 - (D 3 CD (A . 3 U1 Sot CD 3 o m D) z� :. s0 �:3 a =' om N 3' 7 UJ' Lo O O. N O O � a� O r•► =r Zr CD 3 m 7@ O O 0 0 m CA) N c p Z 0 m 11 m a owl To t F 0 ;• ' �w '_ LrT Z m M In O Z M O z v G m G. � cr pro Oth N N (D O b 0 0 W c� a N X A y 00 MA CD CD NCD CO o b A7 n O G G' � d N N (D O b 0 0 W c� a N X A y 00 MA �Csunshine ,� �, 121 Westboro Road Sgrt -6a` O'-) North Grafton MA 01536 j 508.839.5588 fax: 508.839.9929 email: garyc@sunshinesign.com i s www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual) Address: City/State/Zip: NO, Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts ' ^; 1 w � Department of Industrial Accidents AM �� �. Office of Investigations f4'1' 600 Washington Street These sub -contractors have Boston, MA 02111 i s www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual) Address: City/State/Zip: NO, Are you an employer? Check the appropriate box: LI am a employer with 5(D 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and. have no employees These sub -contractors have working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 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. 0 Demolition 9. n Building addition 10.❑ Electrical repairs or additions 1 1.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks bo)1# l most 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 check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: sae Q--/ 1 Policy # or Self -ins. Lie. #: 4J 50301(S Expiration Date: 41161110 Sob Site Address: 60 wCll00.) 3Jif C (f City/State/Zip:-.Ab... �q 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 of MGL e. 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 ,f perjury that tine information provided above 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 #: ��le Boar o ui m e ulaVon an an�ar g g One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Construction Supervisor License License CS: 62908 Restriction: 00 Expiration: 4/16/2010 Tr# 20028 DAVID R GLISPIN 121 WESTBORO RD N GRAFTON, MA 01536 DPS-CA1 a 50f,6-07!07-PC8490 Update Address and return card. Mark reason for change Address Renewal Lost Card •J JlG' �09YC//I7.!/'ILLUP.CLGUL O��t���LdxLfll�xJ Board of Building Regulatio s and Standards Construction Supervisor License License: CS 62908 Expiration: 4/16/2010 Tr# 20028 Restriction: 00 DAVID R GLISPIN 121 WESTBORO RD N GRAFTON, MA 01536 Commissioner 14" 71/2" D O U2' 32 ,/2" 41/4" 18" f-- 3 3/8" 4" 8" 1 120" The Dow Chemical Compan North Andover Facility 60 Willow Street 115" 123" ��nlovterior Monument, Front/Side Elevation a=1'-0" Quantity (1 Description 6" deep single faced custom fabricated aluminum cabinet has painted finish on all surfaces and applied vinyl graphics. Sign is non -illuminated and stands appx. 441/2" tall above finish grade. Typeface Client Logotype Helvetica Black Italic Colors Logo and Underscore: 3M Perfect Match Red 220-263, to match Pantone 185C Red ■ 3M Black ❑ MAP White 1-1 MAP painted to match Pantone 422C Grey ElMAP painted to match Pantone 424C Dark Grey Scale: app sunshine sign company, inc. ` 121 Westboro Road North Grafton, MA 01536 p 508.839.5588 f 508.839.9929 www.sunshinesign.com Client Dow Electronic Materials Project Standard Facility Signage North Andover, MA Marlborough, MA ❑ Approved for Fabrication ❑ Approved as Noted ❑ Revise and Resubmit ❑ Rejected Name Signature This drawing is given in confidence and may not be used or disseminated in any way without prior written consent from Sunshine Sign Company, Inc. All common law and copyright laws are hereby specifically reserved. Date: Salesperson: 14 Aug 09 JR Revision: 14 Oct 09 PM: Drawn by: KD bPM RFQ: 15900-17074 Drawing: DOWC-081409.4 4,X-5 -1 wAj OF P�<OP05C-Z3 -D. -- X l 2,C) 11 s'l,v&tE p-�� momumos qr st6� of IFDI Industrial Facilities Design, Inc. CONSTRUCTION CONTROL AFFIDAVIT (AFTER CONSTRUCTION) PROJECT LOCATION: 60 Willow Street PROJECT DESCRIPTION: Rohm and Haas (Dow) Nitrogen Installation This is to certify that I, as the U Mass. Registered Architect fy 1 Mass. Registered professional engineer responsible for the provision of construction phase services for this project, have complied with the provisions of article 116.2.2 of the Seventh Edition of the Massachusetts State Building Code (architect / engineer responsibilities during construction) as is applicable to this project. OF Mq� JAMES M. yN WOLAtHAN No. 31610 STRUCTURAL \i�,�c� 9� U;STER�� "►w\iQNAL ---JO Name SEAL Architect/Engineer Mass. Reg. # 85 Main Street Phone: 508-544-1695 Hopkinton MA 01748 Fax: 508-544-1694 IFDI Industrial Facilities Design, Inc. CONSTRUCTION CONTROL AFFIDAVIT (AFTER CONSTRUCTION) PROJECT LOCATION: 60 Willow Street PROJECT DESCRIPTION: Rohm and Haas (Dow) Nitrogen Installation This is to certify that I, as the L!/ Mass. Registered Architect U Mass. Registered professional engineer responsible for the provision of construction phase services for this project, have complied with the provisions of article 116.2.2 of the Seventh Edition of the Massachusetts State Building Code (architect / engineer responsibilities during construction) as is applicable to this project. co n m� a No. 6011 0 C NATICK, y MASS. TN OF �Pssp`s SEAL 85 Main Street Hopkinton MA 01748 Robert C. Troccolo 1/06/10 Name #6011 Architect/Engineer Mass. Reg. # Phone: 508-544-1695 Fax: 508-544-1694 Date /0. .... ° • " TOWN OF NORTH ANDOVER �.r _... • OCL PERMIT FOR WIRING v. This certifies that .....J.l. ................... .. f/ " ......................................................... has permission to perform ....� r K : . / r ........................................................... wiring in the building of ... at ...... �U u. f . ( 6 < <. C..?.` Aorlh Andover, Mass. ..... ..... ............................Fee ... /.1...� . �....... Lic. No. 4...... i � ............... .................... ...... ...... ELECTRICAL INSPECTOR Check # 90U7 4IN Commonwealth of Massachusetts Official Use only Permit No. 56�2 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 10/23/09 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) 60 Willow Street Owner or Tenant Dow Chemical Company Telephone No. Owner's Address 60 Willow Street Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Chemical Manufacturing Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: New power and data piping to serve nitrogen tank controller. New lights and receptacles for fill station area. Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 3 Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Batte Units No. of Receptacle Outlets 2 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 1 No. of Gas Burners No. of Detection and 2 Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number . . . Tons .. .. . .. .... KW ................ No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers HeatingAppliances KW pp Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: 1 Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors I Total HP 1/2 Telecommunications Wiring: 1 No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 10/26 Inspections to be requested in accordance with MEC 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 ❑ (Specify:) I certify, under the pains and penalties of perjury, that the in/orX7. on this application is true qqd complete. FIRM NAME: Pi uette and Howard Electric Service IC. NO.: Licensee: Robert Bruce Howard Signatur LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: 222 Plaistow Rd — Plaistow NH Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: 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: $ �� r 77cp i i i 'Y � � l l4 ♦eS' 1 cp fl 04 S f YP ♦,.� � � � �t` "� •, 4 !�'. � "j� t�:-"moi li 1 N vAt �, ,ter �, `�'. ��^ �� ,� "" �•►a�' °` ,. s �`� x: TO,3:' -, ,, d`1 ♦yrs k" i y r [�s' v ODE +� ;` R , v?f rK •f P n� ne- 21 it , a k s� v_ Yg F J . i wsv I ,Z t �. 1, ,k Y. _�,.• �!/ ga�+F �{ � .Yl� ' i � 9 4�.�xy�p,. *y�,,,s„ r _ t f. } F [Y 4 f <r Tr �e � F ` '�! rl 'e� ' ,ick•: � ���''. � � �.'�'TM�.� ' �".� f �: .f'� ♦ t t �� � + �(? �,{ � x.�•• tea: �. � ,� ; i�"1 v a. t , r i ,' 7 T � # ♦ r �� �6 f u � Y4.�•� �n ,X� Y i� y �i � kw�. y s g y k , �vf; `r* z-�r^fi� .c+';Fia ,.�;',�..• +Aa "�''q -sx a �` '��� to � �' - '1 � a�j F' YRt ,�1 t '�g�s",� '�4►� ... n* ..� r � a,> i{ - + s x -+ `moi .. ��`' �� - `. �.- �„�.•.,,, *�+�../ a%�ew Y' Y • � S MG � �. S A. 1 Ott ! •'� t 'rte};, .'" ~ ,, ' `>„w 'lk fs 10 2 74,20 ED „ .y�,,r�.�K,iS� >";� _.. ,.n -f'tiN•1�dr"±ri � 'wr5...s _ ___may°? 4 ra'�`.�—'`�_ �.,.. 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