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Miscellaneous - 80 MAPLE AVENUE 4/30/2018
0 C DECTAM CORPORATION - - --- Specialty Contractors December 18, 2013 North Andover Board of Health 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: St. Michael's Elementary `hool, 80 Maple Street, (Boiler Room Crawlspace) Dear Sir or Madam: 978.470.2860 fax 978.470.1017 RECEIVED E �u 3 U 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Andover, MA 01845 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 26, 2013 thru December 27, 2013 All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, r Craig�tan Sales Estimator CS/cam Enclosure Environmental Remediation Services - Surface Preparation - Facilities Services 50 Concord Street - North Reading, MA 01864 9 www.dectam.com - solutions@dectam.com .d1 6 Commonwealth of Massachusetts 10A1,9.0538— Asbestos Notification Form ANF -001 ec l`Numbe- - DEC 3 U 2013 INSTRUCTIONS 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 6. 7. 8. 9. Worksite Location: BOILER ROOM CRAWLSP a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room Is the facility occupied? Q Yes ❑ No Asbestos Contractor: DEC -TAM CORPORATION a. Name ,NORTH READING c. Cit /Town AC000035 f. DOS License Number CRAIG STARKMAN h. Facility Contact Person GEORGE A. PAGE a. Name of On -Site Supervisor/For FLI T� a. Name of Pro*ect Monitor FLI & Name of Asbestos Analytical La 12/26/2013 a. Project Start Date(mm/ddlyyy 7A -4P c. Work hours Mon -Fri. 10. a. What type of project is this? 50 CONCORD STREET b. Address 01864 9784702860 dd. Zi� e. Telephone Number g. Contract Type: ❑✓ Written ❑ Verbal SALES ❑ Demolition Renovation ❑ Repair ❑ Other, please specify 11. a. Check abatement procedures: AS071933 b. Supervisor/I AA000144 b. Project Mon AA000144 b. Asbestos Ai 12/27/2013 b. End Date (r b. Describe ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup 0 Other, specify: ✓❑ Full containment b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? 0 anf001 ap.doc - 10/02 1 J sbestos Notification Form - Page 1 of 3 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: A. Asbestos Abatement Description When filling out forms on the computer, use 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied only the tab key residence of four units or less? ❑ Yes ✓❑, No to move your cursor - do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return key. 2. Facility Location: +� ST. MICHAEL'S ELEMENTARY SCHOOL 80 MAPLE AVENUE a. Name of Facility North Andover 71 MA : b. Street Address 101845 1 1(978) 686.1862 a c. City/Town d. State e. Zip Code f. Telephone Number INSTRUCTIONS 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 6. 7. 8. 9. Worksite Location: BOILER ROOM CRAWLSP a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room Is the facility occupied? Q Yes ❑ No Asbestos Contractor: DEC -TAM CORPORATION a. Name ,NORTH READING c. Cit /Town AC000035 f. DOS License Number CRAIG STARKMAN h. Facility Contact Person GEORGE A. PAGE a. Name of On -Site Supervisor/For FLI T� a. Name of Pro*ect Monitor FLI & Name of Asbestos Analytical La 12/26/2013 a. Project Start Date(mm/ddlyyy 7A -4P c. Work hours Mon -Fri. 10. a. What type of project is this? 50 CONCORD STREET b. Address 01864 9784702860 dd. Zi� e. Telephone Number g. Contract Type: ❑✓ Written ❑ Verbal SALES ❑ Demolition Renovation ❑ Repair ❑ Other, please specify 11. a. Check abatement procedures: AS071933 b. Supervisor/I AA000144 b. Project Mon AA000144 b. Asbestos Ai 12/27/2013 b. End Date (r b. Describe ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup 0 Other, specify: ✓❑ Full containment b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? 0 anf001 ap.doc - 10/02 1 J sbestos Notification Form - Page 1 of 3 A 4 Commonwealth of Massachusetts t Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) 100190538 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: _ 101500 500 a. Total pipes or ducts (linear ft) �b.Total 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 ft --1 pipe insulation ft. (Lin. � g. Spray -on fireproofing Lint ft _..1 h. Transite board, wall boardLint (Lin. �ft. � �t i. Cloths, woven fabrics Lint– ft —1 f __ 0 k. Thermal, solid core pipe c. 149, § 26, 27 or 27A—F apply to this project? Q Yes [✓] No 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 6.14(2) (g): MATERIAL WILL BE WETTED AND PLACED IN PRELABELED BAGS FOR DISPOSAL 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: d. Insulating cement ft —J Lin. SqL ft --1 c. Date (mm/dd/ ) of Authorization d. DEP Waiver # f. Trowel/Sprayer coatings f. DOS Official Title Sq. ft. h. Transite board, wall boardLint (Lin. �ft. � �t �N f __ 0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? Q Yes [✓] No 500 j. Other, please specify: Lin. ft. S . ft. DEBRIS SCHOOL �o I. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): MATERIAL WILL BE WETTED AND PLACED IN PRELABELED BAGS FOR DISPOSAL 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a. Name of DEP Oficial b. Title c. Date (mm/dd/ ) 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? Q Yes [✓] No _0 B. Facility Description N____1 SCHOOL �o 1. Current or prior use of facility: �o T 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes [Z✓ No -�ST. MICHAEL'S ELEMENTARY 3. 80 MAPLE AVENUE �T a. Facility Owner Name b. Address �0 NORTH ANDOVERi 01845 19786861862 C c. Cit /Town d. Zip Code e. Telephone Number area code and extension ILL 4 NICK IPPOLITO SAME AS #3 a. Name of Facility Owner's On -Site Manager b. On -Site Manager Address �Q c. City/Town d. Zip Code e. Telephone Number (area code and extension) ■ anf001 ap.doc • 10/02 Asbestos Notification Form • Pa e 2 of 3 ■ 14. Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 B. Facility Description (cont.) a. Name of General Contractor r� I� c. Cit /Town d. Zip Code GREAT DIVIDE f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? 100190538 Decal Number C. Asbestos Transportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): ja. Name offTTransporter I 1 I c. City/Town d. Zip Code b. Address e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: SERVICE TRANSPORT b. Authorized Signature b. Address 119720 d. Zip Code 3. d. Date mm/dd/yyyy) a. Refuse Transfer Station and Owner I 4 c. City/Town e. Telephone Number area code and WCA153726610 12/28/2013 g. Policy Number _ h. Exp. Date (mm d/ 9000 MINERVA ROAD 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): ja. Name offTTransporter I 1 I c. City/Town d. Zip Code b. Address e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: SERVICE TRANSPORT b. Authorized Signature a. Name of Transporter NEWCASTLE c. Ci /Town 119720 d. Zip Code 3. d. Date mm/dd/yyyy) a. Refuse Transfer Station and Owner I 4 c. City/Town d. Zip Code 4. IMINERVA ENTERPRISES INC � a. Final Dis osal Site Location Name 9000 MINERVA ROAD c. Final Dis osal Site Address OH "^1 44688 e. State 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. 58 PYLES LANE b. Address (877) 999-9559 _ e. Telephone Number b. Address e. Telephone Number b. Final Disposal Site Location Owner's Name WAYNESBURG d. Citvlrown g. Telephone Number JCRAIG STARKMAN a. Name b. Authorized Signature SALES 1 12/11/2013 c. Position/Title_ d. Date mm/dd/yyyy) (978) 470-2860 DEC -TAM e. Telephone Number f. Representing 50 CONCORD ST_�� q. Address _ N READING 101864 h. City/Town i. Zip Code Go To 7op� 0 anf001 ap.doc • 10/02 Asbestos Notification Form • Page 3 of 3 0 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ate; INSTRUCTIONS Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description ■ 100195975 Decal Number a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied residence of four units or less? ❑ Yes ✓❑ No b. Provide blanket decal number if applicable: Blanket Decal Number 2. Facility Location: (ST. MICHAELS SCHOOL 180 MAPLE AVE�� a. Name of Facility b. Street Address NORTH ANDOVER J MA 01845 ,9786861862 c. Cityfrown d. State e. Zip Code f. Telephone Number 3. Worksite Location: 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 CAFETERIA —1 C== I - ---:] a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room Is the facility occupied? ✓❑ Yes ❑ No Asbestos Contractor: DEC -TAM CORPORATION NORTH READING 50 CONCORD STREET b. Address 864 9784702860 'ip Code e. Telephone Number [CRAIG STARKMAN h. Fa ility Contact Person 6' GEORGE A. PAGE a. Name of On -Site Supervisor/Foreman FLI 7' a. Name of Project Monitor FLI $' a. Name of Asbestos Anal ical Lab 9. 4h 8/2014 a. Project Start Date mm/ddl 7A -4P c. Work hours Mon -Fn. 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 M Other, specify: g. Contract Type: ❑✓ Written ❑ Verbal b. Describe CRITSINEGAIRIWMETHODS b. Describe 12. Is the job being conducted: ❑✓ Indoors? ❑ Outdoors? 0 anf001ap.doc • 10102 1 q 0 l6 1 E_(_1 Asbestos Notification Form - Page 1 of 3 0 W Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) ■ 100195975 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: 10 500 a. Total pipes or ducts (linear ft) . Total oilier surfaces square"if) c. Boiler, breaching, duct, tank j 01845 surface coatings Lin. ft. e. Corrugated or layered paper Sq. ft. pipe insulation Lin. ft. 02184 f. Trowel/Sprayer coatings g. Spray -on fireproofing h. Transite board, wall board Lin I. Cloths, woven fabrics Sq. ft. Lin. ft. 500 j. Other, please specify: k. Thermal, solid core pipe S . ft. 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 6.14(2) (o): 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. Name of DEP Official bb. Title c. Date (mm/dd/ ) of Authorization d. DEP Waiver # e. Name of DOS Official f. DOS OfficialTitle g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes [✓,1 No B. Facility Description 1. Current or prior use of facility: SCHOOL 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes 0 No 3 ST. MICHAELS SCHOOL 80 MAPLE AVE a. Facility Owner Name b. Address 1NORTH ANDOVER j 01845 c. Ci /Town _ d. Insulating cement Lin. ft. Sq. ft. a. Name of Facility Owner's On -Site Manager BRAINTREE 02184 f. Trowel/Sprayer coatings d. Zip C Sq. ft. h. Transite board, wall board (Lin. �ft. _I Lint f Sq. ft. 500 j. Other, please specify: Lin. ft. S . ft. VAT/MASTIC I. Specify 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (o): 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. Name of DEP Official bb. Title c. Date (mm/dd/ ) of Authorization d. DEP Waiver # e. Name of DOS Official f. DOS OfficialTitle g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes [✓,1 No B. Facility Description 1. Current or prior use of facility: SCHOOL 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes 0 No 3 ST. MICHAELS SCHOOL 80 MAPLE AVE a. Facility Owner Name b. Address 1NORTH ANDOVER j 01845 c. Ci /Town _ d. Zip C KENT WILKINS 4' a. Name of Facility Owner's On -Site Manager BRAINTREE 02184 c. City/Town d. Zip C ■ anf001 ap.doc - 10102 1978.686-1862 e. Telephone Number area code and extension 66 BROOKS DRIVE 617-746-5743 e. Telephone Number (area code and extension) Asbestos Notification Form - Page 2 of 3 ■ Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 1=3 L Facility Description (cont.) a. Name of General Contractor c. Ci /Town d. Zip Code GREAT DIVIDE INS. CO f. Contractor's Worker's Comp. Insurer What is the size of this facility? 100195975 _ _ Decal Number - C. Asbestos Transportation and Disposal -- 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): af Transporter ( c. City/Town d. Zip Code b. Address e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: SERVICE TRANSPORT 58 PYLES LANE a. Name of Transporter b. Address NEW CASTLE, DE 18779999559 c. Ci /Town d. Zip Code e. Telephone Number 3. (La`. Refuse Transfer Station and Owner b. Address c. City/Town � d. Zip Code e. Telephone Number 4. IMINERVA ENTERPRISES INC a. Final Disposal Site Location Name b. Final Disposal Site Location Owner's Name 9000 MINERVA ROAD WAYNESBURG c. Final Disposal Site Address d. Ci / Town OH 44688 e. State f. Zip Code g. Telephone Number 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. CRAIG STARKMAN 1craig Starkman a. Nameb. SALES _ �� Authorized Signature b. Address c. Position/Title 9784702860 d. Date (mm/ddd i w) DEC -TAM e. Telephone Number e. Te_ lephone Number area code and extension) ll W�CA153726612 12/28/2014 g. Policy Number_ h. Exp. Date mmldd/ 15000 01864 11 1 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): af Transporter ( c. City/Town d. Zip Code b. Address e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: SERVICE TRANSPORT 58 PYLES LANE a. Name of Transporter b. Address NEW CASTLE, DE 18779999559 c. Ci /Town d. Zip Code e. Telephone Number 3. (La`. Refuse Transfer Station and Owner b. Address c. City/Town � d. Zip Code e. Telephone Number 4. IMINERVA ENTERPRISES INC a. Final Disposal Site Location Name b. Final Disposal Site Location Owner's Name 9000 MINERVA ROAD WAYNESBURG c. Final Disposal Site Address d. Ci / Town OH 44688 e. State f. Zip Code g. Telephone Number 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. CRAIG STARKMAN 1craig Starkman a. Nameb. SALES _ �� Authorized Signature 3128/2014 c. Position/Title 9784702860 d. Date (mm/ddd i w) DEC -TAM e. Telephone Number f. Representing 50 CONCORD STREET Address_ NORTH READING 01864 h. Cityrrown i. Zip Code 0 anf001 ap.doc • 10/02 Asbestos Notification Form - Page 3 of 3 DEGTAM ENVIRONMENTAL SERVICES April 7, 2014 North Andover Board of Health 1600 Osgood Street Building 20, Ste 2-36 North Andover, MA 01845 RECEIVED t:.�;; 14 ZU14 TOWN OF NORTH ANDOV9R RE: St. Michaels School, 80 Maple Avenue, North Andover, MA 01845 (Cafeteria) 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 April 18, 2014 thru April 18, 2014. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Craig arkman Sales Estimator CS/cam Enclosure 50 Concord Street, North Reading, MA 01864 - P: 978.470.2860 F: 978.470.1017 - www.dectam.com Burst pipe causes flood, 3 -day closure at school » Merrimack Valley » Eag... Page 4 of 14 Burst pipe causes flood, 3 -day closure at school By Paul Tennant ptennantgeapletribune.com NORTH ANDOVER — Students and teachers returned to their classes at St. Michael School on Wednesday after an unexpected three-day vacation. A frozen pipe that burst flooded the school the afternoon of Jan. 9. The pipe, located above the computer lab, sent a torrent of water into the room, according to Assistant Principal Susan Rogge. "It was a lot of water" and the flood ruined several computers, she said. A waterfall poured into the atrium below the computer lab, according to first -grader Lily Amari. When the alarm sounded at around 1:30 p.m., most of the teachers and students had no idea what the problem was, Rogge said. "We didn't smell smoke," she pointed out. Nevertheless, everyone vacated the building within three minutes, she said. The Police and Fire departments arrived "in the blink of an eye," she added. Initially, Rogge and Principal Susan Gosselin had no idea when classes would resume. The combination of the Servepro cleaning company and a small army of parents, however, got rid of the water and the mess in short order. Numerous parents called the school to volunteer their help and brought snacks to the volunteers who were cleaning. "It was amazing how quickly they cleaned things up," she said. The Health and Building departments checked the building and tested the air quality "to make sure there was no mold," she explained. Following the school's emergency procedures, students and teachers crossed Main Street and gathered at St. Michael Church. While waiting for Gosselin to give them an update on the crisis, they sang songs and recited the rosary, according to Cheryl Amari, the mother of Lily and Jill, a seventh -grader at the school. "We have a great community," Rogge said. "Everybody pulled together." The firefighters and police officers retrieved the children's backpacks and other belongings from the school. "It was really appreciated by us," she said. http ://www. eagletribune. com/local/x65117773 5/Burst-pipe-causes-flood-3 -... 1/17/2014 Burst pipe causes flood, 3 -day closure at school » Merrimack Valley » Eag... Page 3 of 14 0 comments < 0 0 Start the discussion... C� SIGN IN WITH 10 O 0 Sign up for Disqus OR REGISTER WITH DISQUS Gisqus is a conversation network . Disqus, never.moderates.or. censors. .The xules,.on. fl ommunity are its own. our email is safe with us. It's only used for `mod eration`and'optiona1, notifications. Don't be a jerk or do anything illegal. Everything is -easier that way. Read, full, terms_ and 0 Newest Community Be the first to comment. Top Commenters on The Eagle -Tribune Tnn Discussions nn ThP EanlP-Trihune comments powered by Disqus January 17, 2014 Share L http://www. eagletribune.com/local/x65117773 5Burst-pipe-causes-flood-3-... 1/17/2014 This certifies that ........... . ...IC.. / .. k .C2." .................. has permission for gas mstall i n .... ...... ........................... in the build* f C-- (nC,-Q � -.,, ................................ ... I . 5 . -.- .. ........................................................... .. . ............ Ps .. 1. ........... ...... ... .... at ........ 8�0 ........ ..... ........ . .... North Andover, Mass. Fee.......�) ... Lic. No.. ... ............................................. ( GAS INSPECTOR Check #07+0 1z!� !1 .................. Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 9021 UNVENTED ROOM HEATER WATER HEATER OTHER " INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I ANO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE/RAGE BY CHECKING THE APPROPRIATE BOX BELOW J, LIABILITY INSURANCE POLICY 'W OTHER TYPE INDEMNITY ' BOND i OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge Z and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ccccs� PLUM BER-GASFITTER NAME MICHAEL H HOUSE LICENSE # 7173 SI T E �► MP `//MGF JP JGF LPGI CORPORATION V# 3377 C PARTNERSHIP # LLC # COMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS 15 AEGEAN DRIVE, UNIT #3 CITY METHUEN STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-884-3427 EMAIL Ilittle@mvalleycorp.com or sruaer@mvalleycorp.com r�' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1` r-� GOWNERADDRESS TYPE OR PRINT CLEARLY CITY Al��Drw; d MA DATE PERMIT # J 0 B S I T E ADDRESS /�%9 /�' `r OWNER'S NAME57 AC`Ir9E� ��j�►/j %9� /!% �.[tC✓ /�� C� TEL FAX: OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: RENOVATI n EPLACEMENT: I / DC PLANS SUBMITTED: YES NO APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER - - ROOF TOP UNIT TEST i innT urnTrn _ -_ UNVENTED ROOM HEATER WATER HEATER OTHER " INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I ANO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE/RAGE BY CHECKING THE APPROPRIATE BOX BELOW J, LIABILITY INSURANCE POLICY 'W OTHER TYPE INDEMNITY ' BOND i OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge Z and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ccccs� PLUM BER-GASFITTER NAME MICHAEL H HOUSE LICENSE # 7173 SI T E �► MP `//MGF JP JGF LPGI CORPORATION V# 3377 C PARTNERSHIP # LLC # COMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS 15 AEGEAN DRIVE, UNIT #3 CITY METHUEN STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-884-3427 EMAIL Ilittle@mvalleycorp.com or sruaer@mvalleycorp.com r�' C F O 7 z 0 Z Q Z M � >O El z 7_ O '^ i El w a � F C) Wo F a # Z LL) �- fn N d' W Z w a a a o c z W Q fs7 N .a U z Q o a U = J F a CL Q � N W 2 W LL N F O z z O F U a v; z Q U x U 0 a '.1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) :_ Address: !� /�% �i�•y ,�,Pr� City/State/Zip: AeVWdeeL) 41i1 e/el $1 Phone#: Are you an employer? Check the appropriate box: 1. I am an employer with 4.0 I ,- am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2. 0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance. # required] 5. F.1 We are a corporation and its 3. ] I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Type of project (required): 6. El New construction 7. 0 Remodeling 8. L_' Demolition 9. 0 Building addition 10. 0 Electrical repairs or additions 11. 0 Plumbing repairs or additions 12. C Roof repairs 13.ybther, *Any applicant that checks box i#1 must also fill out the section below showing their workers' compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for » information. ry employees Below is the policy and job site Insurance Company Name:_ /7�(��j ,- f�i�.E.✓,� j Q,�iq �t(� L 9, J Policy # or Self -ins. Lic. #:,0%�/�i(�,�/�� Z4:L /� j/ ZQ/�? v Expiration Job Site Address:�j�� City/State/Zip:All 1 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby ce u der tpat PS Si,enature: Print Name: c the information provided above is true and correct Date: Phone #: 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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone COMMO #WEALTH OF MASSACH SMS ' Date .. � ).3..!. ! - - ....... TOWN OF NORTH ANDOVER 9 • PERMIT FOR GAS INSTALLATION This certifies that .. ri (" C.' inI,q P Cod , , , , , , has permission for gas installation' in the buildings of. ! `, ' �� .. , C 4.c� f ... , _ , , , . , at .. &U .%ar �f?... j?��%.........., , North Andover ,M ss. Fee.)(rq,, P . Lic. No.. ......... A ............. GAS INSPECTOR Check # -5—%06 8229 EO M m W 7_ z 0 F U w 0. z d z w is W z z 0 ❑ w � ~ W O a z w rn to w ; Z N a a w W d CW7 zz a Q � a. a � U r F °' CL Q 44 w 2 w H LL W F- O z z F U W a Q C7 x O a 0 mi Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . /*r/_1 y`"l�'�" .. 1 !:L/P ... c`"!p has permission to perform ef�E'-!�t�fP�.�'¢''lfj ��,� �P!� %�T',�fzcS plumbing in the buildings of at. ... fav .........../... , North Andover, ass. Fee.yYf,./-F. Lic. No..7�73... �c`?�i��f'airr.�f-� ... . PLUMBING INSPECTOR Check # _ 106 C /00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ...... s ° F CITYL��� MA DATE 3 PERMIT # JOBSITE ADDRESS'Go � — OWNER'S NAME' POWNER ADDRESS TELA FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ; EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: �j RENOVATION: �j REPLACEMENT: [] PLANS SUBMITTED: YES K -J' NOO FIXTURES -1 FLOOR- BSM 1 2 3 1 4 1 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM F DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _.� ____.. DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER j [ f FLOOR /AREA DRAIN L 7 INTERCEPTOR (INTERIOR) I 1 . .._ KITCHEN SINK LAVATORY ROOF DRAIN '- SHOWER STALL _- 1 SERVICE / MOP SINK ^` TOILET URINAL% .. - - __ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING .. i OTHER _ s ,I W INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES [+] NO [j IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [-]' OTHER TYPE OF INDEMNITY n BOND [-1 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT F1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge provision of the and that all plumbing work and installations performed under the permit issued for this application will be in cofhpliance with all PM"It % Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (�� �� r Ak 1Q PLUMBER'S NAME {- MICHAEL MICICH-HOUSE ! 1 ( LICENSE # 7173 SIGNA E � MP[jJPD] CORPORATIONI�# 3377C PARTNERSHIP[]#(._.JLLC[�]#= COMPANY NAMEREM RIMACK VALLEY CORPORATION ADDRESS 115 AEGEAN DRIVE, UNIT #3 CITY1 METHUEN STATE MA , ZIP 01844 TEL 978-68.9-0224 [978:689-2206 FAX 3i 978-689-2„µ 206 1 CELL 978-815-45- - 23 _ EMAIL LLITTLE@MVALLEYCORP.COM /00 W E� z 0 U W a � z a Q z w o0 Z z 0 o � w w O W W z O a a �i W Law w W 3 N a C 0 w a � U J Q CL to a � w U. A, a W � N z z 0 U W C6 z � V z CL1 a ow a o a v a` 1 t 0 J This certifies that .... ��... ,hd.�'... � <, • • . , , • . , • .. • • • has permission to perform .. `�?� .. /,� , . , , , • , • . • • .... . wiring in the building of at . , (. ,B.Y%44J... S?' .. . .......... . . . . North Andover, Mass. Fee 12 - . Lic. No... %t.%k.. ...../•.. .. . I ELECTRICAL INECTO�� Check # ✓ 10977 Commonwealth of Massachusetts Official Use Only R Department of Fire Services Permit No. 122 `7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: !]— t r1— I?— City ZCity or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention topErform the electrikal )#ork described below. Location (Street & Number) Owner or Tenant S71 Owner's Address �Ct in Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building Existing Service New Service Telephone No. 0116 &kL 40 r -r% (Check Appropriate Box) Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Meters No. of Meters 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. ❑ o. o mergency Lighting Battery 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 g 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 Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Kms, 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. 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. 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: �j '� L_ NE77 ' LIC. NO.: Licensee: Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No4O V3 2 Address: 1 Alt. Tel. No.* 03 &-'1 R • &22-4— *Per M.G.L c. 147, s. 57-61, security work requires Department of Public S fety "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 PERMIT FEE: $ Signature Telephone No. e^ 3/, /�Z C100A TELNE-2 OP ID: NN '`' ", CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07, 6112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 603-890-6439 Planright Insurance-Salem603-890-6521 224 Main Street Suite 3C Salem, NH 03079 Kelly Bryant CONTACT NAME: PHONE AIC No Ext : IFAR A1C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 1 INSURER A : Peerless Indemnity Ins Co 18333 INSURED Tel Net Inc Gary Anderson 3 Industrial Dr Unit 9 Windham, NH 03087 INSURER B: Excelsior 11045 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMRER: 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. !NSR LTR TYPE OF INSURANCE AUUL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR North Andover, MA 01845 CBP4156629 08/01/12 08/01!13 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS- COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS HIRED AUTOS X NON -OWNED AUTOS BA4156679 08/01/11 08/01/12 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIABOCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC4156680 3A STATE MA & NH 08/01/12 08/01/13 WC STATU- OTH- XTORY E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYEE $ 100,000 E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWNNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Date .. . 2 .. . This certifies that.. , l D u �' 7... S �/« ...... fIt has permission to perform . !`S....'tii .�..(.................. . wirier in the building of� � !�! C . � . s .. SC -t acqL at .Kd . M''. L. ..I#V4F.•. ....... , orth Andover, Mass. Fee. 334 Lic. No.. �Q 8 ..... �'� . ELECTRICAL INSPECTOR i Check # 7l6 �► 10921 -� TOWN OF NORTH ANDOVER PERMIT FOR WIRING - Th" is IRING` liis Certifies that ...Oc%rl�... (...... .. r r� ha's permission to perform A.. , .. �; , , -- wiring in the building of ..? 7^ .! (G!-� . S �� . S� Ae?l at.. U.Q. ! L C ... 4-4-1C ........... No . Andover, Mass. Fee . 3 `r" : tic. No..l ..... 3 .. .... . ELECTRICAL INSPECTOR , Check # 732. 10942 low./ (f1m.nwn :#a Ulf of r//4t1ackujalb 2aparfmant of ira Servicei BOARD OF FIRE PREVENTION REGULATIONS Permit No Occupancy Occupancy and Fee Checked �� 1100-1 tev.l/07) (leas•ebtanlI APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All cork to be performed in accords cc the %I3:,Sachu3ets Electrical Code (NIEC). 531 ChIR 13.00 (PL E4SE PRLAT A' L'\*K OR T}4), LL LVFOR tL4TIO.%) Date: ` / ` _ Cit} or Town of: Ando v -Per To tete Inspector of Sires. B t'ti a;p!lcation the urdtrsl:rned gists notic'. of his or her int'.ration to per` rrn the fie�irlCa! work described belJ'h. Location (Street & Number) 2%) m&AAp PLY ONS n,r Or Tenant �1-� 1 �)f i fla (t-iln� �[16— / Telephone No. �%�' �R n 0%sner's Address amt— IGener KN'A \'� of Luminaires IS«imming Pool AUo�e _ nd. Is this permit in conjunct,in "ith a building permit'. les EL No ❑ (Check Appropriate Bos) Purpose of Building WMm � L tiliry Authorization No. Existing Sen ice .Amps / VOIt; Overhead ❑ Undord ❑ No. of deters Vie" Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Nl?tern Nu r.ber of Feeders and Ampacits To I Tors I K�1 i \o. of Selfm; - nned Dete-' AIertingDe�ices Location and Nature of Proposed Electrical %%orl,: \ CC _ : 0; l%: ' L�'i J.: i,:? f,:'.'e r:.: - t:%,-- ).of Rece;sed Luminaires INo. OrCeil.-Su;p. (Paddle) Fans I\o. of Iot.11 Transformers K\ \,. of Lurninaire Outlets INo. of Hot Tub; IGener KN'A \'� of Luminaires IS«imming Pool AUo�e _ nd. ❑ In- grnd o. o mergence Iii tmg Batters Units No. of Receptacle Outlets INo. of Oil Burners FIRE ALARMS I\o. of Z nes No. of S',%itches No. of Gas Burn No. of Detection and tr,itiating Deices \o of R•tn,es l No. of Cond. Total Tors No. of.�!erti^Q D Ices NO. of 1l3ste Disposer;Number To I Tors I K�1 i \o. of Selfm; - nned Dete-' AIertingDe�ices \o. cf Di;`t}%ashers I�pace.':1rea Fleatln, �IunlClp:tl Lc�c:tl ❑ ,. ❑ Ot;;er Connection \�. c Dfs I\o•of �at,r 1leaters }`�1 l{:a'In?.-�pF1ia�C2.iSecurity No. of I Si_ ; I hU \O. Of Ballast; \ stems:` I- No.*of be%ices or EQui%a!:n; Data N% iring: \o. of De�ic:s or E WF"?!?rat �o. lkdromass3ae Bathtubs INo. of Motors Total HP Telecommunications 1�irinc: No. of Dei ices or E uisalent 0TH ER: . .J:ed 31U� Of E1e.'CICa! �� E;. Jrk: QQ (�� he^ rqu. ed b} municipal 0rk to S:ar . lnsrecliJi's to I'e ,'quested Ir, a:LQfdal,:e s\lin N1CC Ruie 10, a. bion com.!=tion. IN SL R_ -\,CE COVERAGE: Un!ess st1 _ p _,.- - t,",;. ,1 � c :�'.� b': I'e Q\lC no eTnil fJr Ih: perfJT:' �� Jt e� `,:irica! l�Ofk Cil\ lig:. �"-=�; po,j4esprooforliabilityI;uranceIr;!udl^2'Nr,ir!.f'deperan n" �_r' ' _ 0 CU C, lu s'_'z,;=zial equlsa!en r. 1 .r;., certlties that such coserage i; in force, ad ha; exhibited r r n' - p oo� of same w t' _ F. rr:nt issuing o TI:e. CJiECf;O'�E: INSURANCE BOLD ❑ OTHER ❑ (Specie:) �iQh: i'%7 l�:h�S �'C'f��n q -.i- 43 wider lire pains and penalties ojrperjury', ri:tlt lire in.rormarion on !itis cpplira.ion is fr:; � crrd cvn pyre. FIR_NI NA N I E Q EA11rr. c ryi(r _ LIC.INO.:__Fi Licensee: - , Signature LIC. NO.:�r "error r" in rr,e lac nil rt or^✓^ lir.r C �r ? 1 us. Tet. No.: ;Address: � �r _�,� Si.PCa r TA un�m Mn (� � � � C A1c. Tel. No.: 'Per I.G.L. c. 147- s. 57-614zcurity stork requires Department of Public Safety�'•S" License: Lic. No. S$C 1 [ e+C 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. O%s ner/.agent I� Signature Telephone No. PER t!?"FEE: S �t�l�~ L S' b-9 ®`�— C -.-,tel ,Pill f X4 �� eR-31-1z a The Commonwealth of Massachusetts Department oJ'Industrial Accidents (I/rce of /nvesligaliotry `: � bt/ll Was/lintflorl Slree! Boston, MA 02111 W mnlass.govldia Workers' Compensation insurance Affidavit: 13uilders/(-,'ontractors/E.lectricians/Plumbers Applicant Information Please Print Legibly NaniC (Business/Organir.alion/Individual►: Address: City/State/lip: lau-o k-) ) , W) Phone #: Are you an employer? Check the appropriate box: [� { am a crnp!(� er vvitl; w _ 4• ❑ I am a general contractor and I ` employeesFul and/or part-time).* have hired the sub -contractors ❑ I am a sole oprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* required.] 3. ❑ I am a homeowner doing all work mysel F. [No workers' comp. insurance required.] We are a corporation and its officers have exercised their right of exemption per MGI_ c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] VC, 1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition �. ❑ Building addition 10.Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other * Anapplicant that checks box # 1 pout also 1111 out the section below showing their workers" compensation policy inlbrmation. I lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afidacit indicating such. ,Contractors that check this box nntst attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. Ifthe sub -contractors have employees. They must provide their workers" comp. police number. 1 am an emploPer that is providing workers' compensation insurance fpr n1V enlphVees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:_b u Q Expiration Dater/�� Job Site Address: � }7I� V City/State/Zip:flJ110�_u_tqf 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 tine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine ofup 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. du hereby c•ertift uncler the pains and penalties of perjury that the information provider/ above is true and correct ❑ (Vicial use onlr. Do not write in this area, to he completed ht' citr or town official. City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk d. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: This certifies that Date .-#V . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING .... Cogs has permission to perform .....4 ?.Lo... wiring in the building of at . AV .-...5 ?7 ............... . rth Andover, Mass. 1-IZLic. No.-....Fee.f:. ELECTRICAL INSPECT i R Check # 11033 _ Commonwealth of Massachusetts Official U, seOnly 0 Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. l/07] eave blank APPLICATION FOR PERMIT TO PERFORMELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (ME ), 527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL XFORMATIOA9 Date: k I1, f' a, _ 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) L5,-/- M I C A P/ Owner or Tenant 1)l' LA -I I r h 4 e, f & �, Owner's Address m A4 � 6'07,- .N, %iii+, . ]A Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building C / a Sr )r p.p Existing Service Amps / volts New Service Amps / volts Number of Feeders and Ampacity Telephone No. No LJ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans r s Transformers ota KVA No. of Luminaire Outlets No. of Not Tubs Generators KVA No. of Luminaires Swimming Pool Above Md. ❑ In -No. grnd. of Emergency LAghting Batts Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: nm r Tons IKW No. of Self outamed Detection/Alerting Devices I I No. of Dishwashers SpacelArea Heating KW Locel ❑ ConnectiManicipalon [IOther No. of Dryers Heating Appliances KW Security Systems: No. of vices or Equivalent No. of stet KW Heaters Na. of Signs BNo.al of Ballasts Data Wiring: No. of Devices or Equivalent Jr No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or inngg• uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 0 G p, (When .required by municipal policy.) Work to Start: 6Z yl P, 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 verage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE * BOND ❑ OTHER ❑ (Specify:) I certify, ander the sins and penalties of perjury, drat the information on this applicadon is tare and complete FIRM NAME: ��1 b / llC, ZAx, LIC. NO.: a Licensee: t Signature LIC. NO. Addpress•81e enter "exem�t»int a tine. Bus. Tel. No.•7 4�® Alt. Tel. No.: '7 R J � � r- vim% *Per M.G.L c. 147, s. 57-61, security work r uires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent Signature _ Telephone No. PERMIT FEE: S a,7, 6'D y B BL, GER_ TINGATE VF L1A15ILITT MUKANGE- - — os/16/2012 PRODUCER 781.396.4900 FAX 781.391.7597 J. J. Ruddy Insurance Agency 153 Main St. Medford, MA 02155 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED EAST COAST ELECTRONICS CO. INC 296 SALEM STREET .MEDFORD, MA 02155 NSURERA: Citizens Ins Co. of America 31534 INSURERS: Mass Bay Insurance Company 22306 NSURERc: Hanover Insurance Company 22292 INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE -BEEN ISSUED TOTHE INSURED NAMED ABOVE -FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRla TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DAM POLICY EXP! TION LIMBS GENERAL LIABILITY OBNO200578 06/01/2012 06/01/2013 EACH OCCURRENCE $ 1,000,0001 -1 LVMMtWL. btNtK LVACIL111 Mfnfx✓(nnynmr—nn) R 5,00 ra amnv Mill v- �nrcnw A PERSONAL &ADV INJURY $ 1y 0001.00 GENERAL AGGREGATE $ 2,000,000 OCn'L nOORCO/TC LIMTMnLICO nCR. FI J CTPni Ir.Y PRO hRODUCTO coreroor noa m 2,000,00 AUTOMOBILE LIABILITY ANY a ITO ALAQ0240337 06{01/2012 06/01/2013 COMDINCD GINGLC LIMtr {td dcclden(1 1,000.000 BODdY PJJVRV X X I unc�u PAJ I v:i BODILY IN URY Q x. 1vVly-V rrrvcV ,�L11w PROPERTY DAMAGE $ (Per accident) 1,000,000 GARAGE LIABILRY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY OCCUR Q CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WHN0240274 06/01/2012 05/01/2013wcsTATu- OTH- TI R FR EMPLOYERS' LUIBILRY E.L. EACH ACCIDENT $ 100,00 C ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? It yes, describe under E.L. DISEASE -EA EMPLOYE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 SPECIAL' PROVISIONS below OTHF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS St. Michael's Parish 196 Main Street N Andover, MA 01845 ACORD 25 (2001/0B) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE y/�./ ,,. Edward Hackett, CIC, CEWEH Saekfw OACORD CORPORATION 1988 1 5 i Date .. 7/ � �...... . c NOATy . TOWN OF NORTH ANDOVER a PERMIT FOR MECHANICAL INSTALLATION 1 �o . This certifies that � ..��P � �'`.�!`� �:. .u. �.�. , , Gl? ... , , , has permission for mechanical installation4 .... . in the buildings of at ........ e...... , North Andover, Mass, Fee..-- Lic. No....! .... ........ :................ . GAS INPPECTOR WHITE: Applicant CANARY: Building Dept. 1 PINK: Treasurer Commonwealth of Massachusetts Sheet,Metal Permit Date: .3 O� � Permit # r � Estimated Job Cost: $ Permit Fee: '$ �Q Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant -License # Business Information: Property Owner /'Job Location Information: Name: z�.c �ii✓Ir9 �U.f��� Name:d / g fit/ ed,11,01"G Street: Street: Q! City/Town: ��t '✓J, 4/1 axemt Y City/Town: IV. -'V x5 419©/6345— . ' Telephone: 9 �����—Qtj Telephoner Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Initial J-1 1- nrestricted Iicense J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less Residential: 1-2 family Multi -family Condo'/Townhouses Other. Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under'10,000 sq. A. over'10,000 sq. ft. T Number of Stories: Sheet metalwork to be completed:_ New Work: Renovation: HVAC _ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes,'indicate the type of coverage by checking the appropriate box below: 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 112 of the Massachusetts General Laws, and that my signature on this permitapplication waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[], I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the -best of my knowledge and that all sheet metal work and installations -performed under the permit issued for this applicatiod will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO 'Progress Inspections Date Comments r Final Inspection Date Comments Inspector Signature of Permit Approval " 4,01,1 Signature //of Licensee License Number: 077 Check at www.mass.aov/dpl I Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Permit # ❑Joumeyperson-Restricted Fee $ Inspector Signature of Permit Approval " 4,01,1 Signature //of Licensee License Number: 077 Check at www.mass.aov/dpl I mft N wmeusls T psi N N vI a ��4JJ 0 `o - m QLU C c C a c o �L 0� _ • a0 2 g N N o H Q�< WLU(� U J F o VI = c � 0 UJ� W. • . Tus .'.. W' W O-j J 3 co N O o� Q w CL M O >- N COW H x OFold, Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETT.2 BOARD OSHEET NMTWL WORKERS Sm "'ASA BUSINESS ISSUES THE ABOVE LICENSE TO: TYPE I LL -IAM 'S CORSO NER'RIMACK VALLEY SHEET METAL —B 20 :'AEGEAN DR ic MA 01844=01000 968716 45 08/24/12 068716 Fold, Then Detach Along All Perforations 0 E0 The Commonwealth of Massachusetts Department of Indusirkd Accidents Office of Invesfigadons 600 Washington Street Boston, Mass. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrmMization/Individuah - i&o�i�'1/.li�f Add City/State/Zip: Phone#: 978Av��c� Are you an employer? Check th�ropriate boa: 1. I am an employer with 4.0 I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees " These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance. $ required] 5.0 We are a corporation and its 3.!] I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance reqs] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] "Any applicant that checks bo: #1 mast also tin out the section below showing their workers' compensation tHomeowners who submit this aff davit Type of project (required): 6. 0 New construction 7. Remodeling 8. 11 Demolition 9.0 Building addition 10.0 Electrical repairs or additions I I-XPlumbing repairs or additions 12. 0 Roof repairs Ptd v cating they are doing an work and thea hire outside contractors mart submit a new aWdavit indicating sack. :Contactors that check this bo: most attach an additional sheet showing the name of the subarontractors and state whether or not those entities have employees. if the sub -contractors bave employees, they mast provide their workers' coma Policy number, I an employer that is pratda rtg workers inffoormation. ' compensation insurance for ray employees. Below is thepolicy and job site l Insurance Company Name: �.�/��(.r/.�G�i�./.�4�/Us�d / .e— 1. ll Policy # Job Site Expiration 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains andpenalties ofperjury that the information provided above is true and correct. _Signature: Date, Print Name: Phone #. Official use only Do not write in this area to be completed by city or town official City or Town: Perms Mcense M Issuing Authority (circle one): ].Board of Reath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #• mm Date .... .:F!�.7 ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............:l.......................^�-�✓........................... has permission to perform,>-�r`-" -� ��--a�:!� -� -� ... wiring in the building of .......................................... :....... .........at..r�...................... North Andover, Mass. da ee ��� .... Lic. No%/ ....:......... �-7-tt.!............. ....................... ELECTR.cALJ .PECTOR Check # 7562 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 6J_ BOARDOF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked A15 [Rev. ' �R11 /99 � leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: July 31, 2007 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) 80 Maple Avenue Owner or Tenant St. Michael's School Telephone No. 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 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: New HVAC system and exhaust fan installation. Cmmnlotinn nftho fnllnwin mhlo .,,.,,, h., , d 1, oL, 1 --- No. -- 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 ❑ In- rn1:1o. rnd. d. mergency ig ing o Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners 3 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 PumpNumber Totals: . * Tons I ...................... KW - ................ 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 Si ns Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors 5 Total HP 15 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 ❑ (Specify:) Liberty Mutual 4/23/08 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: D&D Electrical Contractors, Inc. / DNET Cabling LIC. NO.: A11933 Licensee: Douglas P. Lynch Signature LIC. NO.: 24594 (If applicable, enter "exempt" in the license number line.) el. No.:781-932-0707 Address: 247 Salem St. Woburn, MA 01801 Alt. Tel. 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. $125.00 Date.... 1:0 )1. TOWN OF NORTH ANDOVER 0- PERMIT FOR WIRING a�4 This certifies that ........... - Z! -x 13, 4 ...... � -ze-n7 ....................................... has permission to perform ........Pe °.r ..... .. ............. wiring in the building of ....... .. M.. 1 .......... . ....... at ............. M-Ckk .... 17........ ................. North Andover, Mass. Fee ...f7..... ........ Lic. No.51'33,� ............. /, ............ ELEcTRICAL INSPECTOR Check it S' 9,171 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No./ Occupancy and Fee Checked [Rev. 1/07] tIPAVP i,hnL� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Co4(ME)5 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION)Date:City or Town of: NORTH ANDOVER To the Inr of Wires: By this application the undersigned gives notice of his or br intention to � the electrical work described below. Location (Street & Number) it)1M , Owner or Tenant Owner's Address No. Is this permit in conjunctionkith b Puose of Buildin u' 'ng permit? Yes ❑ No ❑ (Check Appropriate Box) r P r5 =�L-,rtw I Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps _ / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and. Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires Completion of the No. of Ceil: Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Above ❑ In- d, rn No. of Receptacle Outlets No. of Oil Burners No. of Switches No. of Gas Burners No. of Ranges No. of Air Cond. Total Tons No. of Waste Disposers Heat Pump Number Tons I Totals: _..._.._....... _.... _.._... No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Appliances KW No. ofWatero. , Heaters N of No. of Signs Ballasts o. Hydromassage Bathtubs OTHER: win table may be waived by the Inspector of Wires. No. of Total Transformers KVA Generators KVA o. o mergency ughting FNo.of ALARMS No. of Zonesetection and atin Devices lerting Devices lf-Containedn/Alerting Devices Local ❑ Mnmcil ❑Other Connection Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or Eauivalent of Motors Total HPI felecomn No. of Estimated Value of Elec Attach additional detail if desired, or as required by the Inspector of Wires. 'cal Work: (When required by municipal policy.) Work to Start j Inspe tions to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE GE: Unles waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liabil' insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov rage is in force, and has exhibited proof of s pe t 'ssuing offi e. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) � Z I certify, under the paw nd penalties of perju , that the i orm n this a lication is tru FIRM NAME: �lJ,d pp a and c mplet LIC. NO.• J Licensee: CJ Signature LIC. NO.: (If applicable, er,"exe tin the license number lin — Address: ( Bus. Tel. No.: *Per M.G.L c. 14 , s. 57-61, security work r quires Departrnent of ublic Safety "S" License: AILL cl. No. No: or r 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. $ `�� L i Ir � Location 1!�4() r I IC LPri� No. 1r� - Date 3 N,90 , TOWN OF NORTH ANDOVE J F p Certificate of Occupancy $ Building/Frame Permit Fee $ '� s "A"°''•t� � s+st cHu Foundation Permit Fee $ a ®3s Permit Fee $ — Sewer Connection Fee $ Water Connection Fee $ TOTAL $ U • =`� 0(-40-70305 /Building Inspector 10806 Div. Public Works No: to N°RTM TOWN OF NORTH ANDOVER of 4t..o ,, i•y° � p Certificate of Occupancy $ Building/Frame Permit Fee $' sACHU t� Foun �Wermit it Fee $ ' t $ 0 3 Sewer Connection Fee $ Water Connection Fee $ TOTAL $S Briding Inspect6r ° 10887 Div. Public Works Location., `i F No. Date TOWN OF NORTH ANDOVER / 5/97 10:34 177,86 Aifing Inspector r. 1084 Div. Public Works Certificate of Occupancy $ �> Building/Frame Permit Fee $ sAGMU�+ ACmU E� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ / 5/97 10:34 177,86 Aifing Inspector r. 1084 Div. Public Works p` Location No. / Date / ViORTq TOWN OF NORTH ANDOVER gwin�wdlw p Certificate of Occupancy $ Building/Frame Permit Fee $ � b��sw ►��� Q �sAtMUSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ o / Building Inspector a~n N? 10766 Div. Public Works o LocationVx, / e (S No. 2 Date 7 NOTOWN OF NORTH ANDOVER 1D `ao '�.1ti0 CL \ Certificate of Occupancy $ Q # Building/Frame Permit Fee $ -^ ° ,sIACMUSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ N O ildingInspector 0 10762 Div. Public Works LS+.�+^"""'1h� "` -, :.y- _rw'-• �'ti.. _.TSS".+�'v ^.�f+� '�4' -• - - -- . - „Y ?� Location No. Date 9 f TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building(Frame Permit Fee $ �S eo ,&.I CMUSFoundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ x Building Inspector l i 10 8 15197 10:34 ,00 pplD ,` Div. Public Works Date......`.......... .. f NORTH '1 + TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ....... ( ... . 2 ... ...... ( ....... . ........ ............... has permission to perfor—ra-1-114--.1.. wiring in the building of ......... ................. I ......... at ...................... ... . ........ 4L ........... *"""" North Andover,,Mass. �/ AVZ;i� .............. Fee.:�k ............ Lic. No - - /LE Check # 67 Job # 161 "'�`"�_:._ Coi�wrwruuealZlx o� YV/aaaac�iaaeEEa )� L �Uepartment of Jire Services t..= BOARD OF FIRE PREVENTION REGULATIONS Official Unse Only Permit Occupancy and Fee Checked [� [Rev. 1/07] (leave blank.) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All worlt to be performed in accordance with the Massachusetts Electrical Code (WC I� (PLL'ASE PRINT IN INK OR TYPE ALL INFORMATION) ]Dante: .� City or Town of: North Andover To the bupeclot o f Yfjit°es: ___ By this application the undersigned gives notice of his or her intention to perform the electrical wort: described below. Location (Street &Number) rMan1 P 4tr ..t Owner or Tenant S t . Michael School Telephone No. Owner's Address is this permit in conjunction with a building permit? Iles ❑ No (Check Appropriate Box) Purpose of Building o m m e_rc i a 1 Utility Authorization No, Existing Service Amps / Volts Overhead ❑ Undgr•d ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number offeeders and Ampacity Location and Nature of Proposed Electrical Work: Install 1 smoke detector, 2 door holders and.7 surge suppressors Conn rletion ofthe follou,ir7g table n7av he waived by the In )actor oi'If'ires No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers RVA No. of Luminaire Outlets No. of Hot Tubs Generators RVA No. ofLuminaires Above Swimming Pool ❑lit- ❑ Rrnd. rad. o. ol EmergencyLighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No, of Switches No. of Gas Burners No, oi' Detecflon and �► Ltitiatin Devices No. of ltar►oes No. of Air Cond. Total 'Pons No. of Alerting 7 Devices No. of Waste Disposers Heat Pumh Number I Tons I RW No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers S p` ice/Area Heatingmunieipal RW Local❑ ❑ Other Connection No. of Dryers Heating Appliances KW Security s'ystems:* No. of Devices or Equivalent No. of Water Heaters l(W No. of No. of Data Wiring: Sims Ballasts No. of Devices or Equivalent No. Hydrornassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Reach additional detail it desired, or as required hY the Inspector of ifires. Estimated Value of Electrical Work: (When required by municipal policy.) VJorl: to Start N p W Inspections to be requested in accordance with MEC' Rule 10, and upon completion. lNSU12ANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provicles 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 sante to the permit issuing office. CHECK UNE: 1NSUl- NCE ® BOND ❑ OTHLR ❑ (Specify:) I certif v, under the pains and penalties of'perjurp, that the information on this application is true and complete. FIRM NAME: Atlas Alarm Corporation LiC.NO.:A4776 Licensee: Paul M_ Rich Signature LIC. N0.:A4776 _ (If al'phcable, e171e1' " in the license )27jn7bei•line.) Bus. Tel. No.•7$1-337—$$66 Address: _1239 Washingtan St _ Wnymnut � MAS 189 Alt.Tel..No.: *Per M.G.L. c. 147; s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. ss Co 000009 OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, l hereby waive this requirement, i am the (check one) ❑ owner ❑ owner's agent. Owner/Anent Signature Telephone No. PF_X1Vll1'FEE: $45.00� /e""I-z riaslar q�rr, erving Eastern Massachusetts and Cope od North Andover Wire Department Wire Inspector 146 Main Street North Andover MA 01845 St. Michael School Subject Location: 70 Maple Street North Andover MA 01845 Dear Sir/Madam: Permit #: S / —3 Job# /&/ Please accept this notice as confirmation that our work at the above subject location has been completed. Should you require any additional information, please do not hesitate to contact me directly at (781) 337-8866, extension 128. We hope to have been of service and thank you for your assistance. Very truly yours, Atlas Alarm /Corporation David Wormald Installation Supervisor DW/sh Corporate Offices • 1239 Washington Street • Weymouth, Massachusetts 02189 • (781) 337-8866 Cape Cod Office • 659ATeaticket Highway • Falmouth, Massachusetts 02536 • (508) 540-5507 ` <".� �' :'•a TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING This certifies that .. �`, C..5. ��.... �'�.. ............... . has permission to perform .... R.0 W. 0.�-.14.?'1111 ............... 4 plumbing in the buildings of ... at .'.. ........ North Andover, Mass. Fee. . 2..!... Lic. No.. Ga.). �.'... 9—,'. �4-�-'?.- ' ....... PLUMBING INSPECTOR Check # 17471 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: IVC M -K Anc�oe-,V' MA. Date: Q �1 Q� Permiitt#� 7 Y Building Location: ' `GL �Q— Owners Name: tA Type of Occupancy, Commercial Educational Industrial Institutional Residential New: Alteration: Renovation: Replacement: Plans Submitted: Yes No FIXTURES U) '-0 Y U In co Q N } � U W (� U) a W z IX z z a �' z Q 0 In x I d W In >- W Q W u N O fl X O m co W 0 Q z �- 0 X x z_ W In t7 U 0- u- ~ Q In X W 0 W N W J Z �1J 0 0 F- 2 Z Q W `'S 0. Y Q = W W W Q a N D -j Q 0 0 0 0=-j QI R Q Q Q �• Q M m o o LL. 0 2 -Y J J X N Ini HI 5 0 SUB BSMT. 11 BASEMENT 1 FLOOR 2 F OR 3FLOOR _ 4FLO RORO 5 lH FLOOR 6T"'_FLOOR — - -- - -- 7T" FLOOR ...................... .---- --- 8"' FLOOR Installing Company Name: Eric C. Foster Plumbing & Heating LLC Address: 145 Stedman Street Business Tel: 978-256-5976 City/Town Chelmsford Name of Licensed Plumber: Eric C. Foster Fax: 978-452-4711 Check One Only Certificate # Corporation State: MA Partnership Firm/Company 04-354-2016 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 of coverage by checking the appropriate box below. A liability insurance policy V/ Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hay.n the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only _ Owner Agent Signature of Owner or Owner's Agent__ _ I hereby certify that all of the details and information i have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ✓ Plumber signatbleoi License m er Journeyman Master I/ City/Town License Number: 9311 APPROVED (OFFICE USE ONLY v; z o - L �- V) z s .u, c; N C7 z m 5_ o CL U ry i `� .� 3 cL a O G cC u] z z r,_ O LU U m O o LU ! u ~ o a z cc a y 69 a a, ¢ LL) m z LijU V) LLJ� z s F W Lu U LU i G � ✓1i 7 2 U W � 'c ,4oRT" Date ...... T. ... ea ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING A 7- L 4 -�, ,akw,.P1 �!/r P . This certifies that ......... ............................................ ............................. has permission to perform ................. / ... �..q ... wiring in the building of ........... ........ at ............... M OPe 7 North Andover, Mass. .. ................................................ Lic. No .............. ............... ....... .. .. ........ .ELECTRICAL INSPECTO 3ell -7 k Check # 8329 Commonwealth of Massachusetts Official Use Onl l Permit No. Z' Department of Fire Services km Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ] 1/991 (leave blank) AAC Job 192 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MSC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. North Andover To the Inspe for o Tres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 80 Maple Street Owner or Tenant St. Michael School Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Q (Check Appropriate Box) Purpose of Building Commercial Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace fire alarm control panel Completion of the llowing 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 In- rnd. ❑ rnd. ❑ o. o Emergency Lighting Batte 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 Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kai Security Systems: No. of Devices or Equivalent No. of Water Kms, Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Anoch additional detail ifdesired, or as required by Nie Inspector o% {Hires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Now 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: Atlas Alarm Corporation ,,,/ ,/ LIC. NO.: A4776 Licensee: Paul M. Rich Signature %f,,�i� LIC. NO.: A4776 (Ifapplicable, enter "exempt"in the license number line.) Bus. Tel. No.•781-337-8866 Address: 1239 Washington Street, Weymouth, MA 02189 Alt. Tel. No.•781-337-8866 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, 1 hereby waive this requirement. I am the (check one) EJ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 35.00 m )C�4 a 0 tc �- t 6 � C)s 19� r Alas ,alarm �.r. Serving Eastern Massachusetts and Cope Cod I() 'Vo 9 North Andover Wire Department Wire Inspector 146 Main Street North Andover MA 01845 Subject Location: St. Michael School 80 Maple Street North Andover MA 01845 Dear Sir/Madam: Permit #: Job# ! q'�- Please accept this notice as confirmation that our work at the above subject location has been completed. Should you require any additional information, please do not hesitate to contact me directly at (781) 337-8866, extension 128. We hope to have been of service and thank you for your assistance. Very truly yours, Atlas Alarm Corporation David Wormald Installation Supervisor DW/sh Corporate Offices • 1239 Washington Street • Weymouth, Massachusetts 02189 • (781) 337-8866 Cape Cod Office • 659ATeaticket Highway • Falmouth, Massachusetts 02536 • (508) 540-5507 R Date .... 7 '....2-7-.. <D 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that...................b� ......... �..441............................... has permission to perform .......... A.t. � N......1CgA � .......... ............ c k wiring in the building of ..... SJ /%'� 1 .......... 5�.%.. r _i ....................... . North Andover, Mass. Fee ...Z .. Lic. No.. q.c.733.14 ...........�,.� ... ...... ` ll E E- 1cAL INSPECTOR Check # to3 F 7592 J If Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 75- �2� Occupancy and Fee Checked [Rev. 9/051 (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:— Z City or Town of: j1/. g,v, 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) �, -r ,0'r/J- 5e-4 t% / %IX,�,/1 '44-111 Owner or Tenant �-'- TelepOgne No. Owner's Address e- __ Is this permit in conjunction with a building permit? Yes Ej�— No ❑ (Check Appropriate Box) Purpose of Building �����.� 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: 4k-` .'L." Completion nf'lha f;i11nw;— i ,hlo No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans .....,... .,...r �� ..,......,u. .1r nac No• o Transformers u.o is �...,r I.J rrur�. Tota KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. grnd. o. of Emergency Lighting Battery Units 2— No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o etection and Initiating Devices No. of Ranges No. of Air Cond.�+ . 2 TonsTota No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number ons K No. ofSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection El Other No. of Dryers Heating Appliances KWSecurity Systems: No. of Devices or Equivalent No. o Water KN, Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Te ecommunicationsWiring: No. of Devices or Equivalent OTHER: ttlac•h additional detail ifdesired, or as required by the Inspector of Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 5 - z 7. _U-7 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 i -in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under lite pains and penalties of perjury, that the information on Misapplication is true and complete. FIRM NAME: LIC. NO.: �J Licensee:m _ _ Signature LIC. NO.:116ff 3 (!l upplicable, ent�i -exerF nipt- in the license number line.) �- � Bus. *ei�- . IVo.:��2��i Address: fic i+-lwvy Alt. Tel. No.: *Security System Contractor License required for this work;'if applicable, enter 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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent SER MIT rEE Signature `�eiephene No. P PI Date. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .../' G . S .1r.1 ............................ has permission for gas installation ..G. r j" `: -* in the buildings of at .. r .o... :....... , North Andover, Mass. Fee.. Lic. No. 0?. 3/!� . .... :..\...-^'`�. ... . GAS INSPECTOR �,, Check # 2 f S 1 xf C) Lo 0 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 of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Aoent By checking this box ❑; I herebv certify that all of the details and information I have submitted for entered) reaardino this aoolication are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1427 f the neral Laws. -- -1--17-- Type of License: By Plumber Title ✓ Gas Fitter s Signatu a icensr3l /Gas Fitter Master City/Town Journeyman License Number: APPROVED (OFFICE USE ONLY) LP Installer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING � W City/Town:, ��('A An 0 � ►� Date: � - � ' U rl Permit# 60 Building Locatio• .. u�. �� Owners Name: Type of Occupancy: ommercia Educational Industrial Institutional Residential New: Alteration: Renovation; Replacement: Plans Submitted: Yes No 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 of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Aoent By checking this box ❑; I herebv certify that all of the details and information I have submitted for entered) reaardino this aoolication are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1427 f the neral Laws. -- -1--17-- Type of License: By Plumber Title ✓ Gas Fitter s Signatu a icensr3l /Gas Fitter Master City/Town Journeyman License Number: APPROVED (OFFICE USE ONLY) LP Installer W � W Z N V m 2 O F- W W 0 U) H _ I H W Z O F- Z J O } OC W Z W IY z O W P W (n o w Z W N > Luto W <60 O F- a.O W Q �`d2 O d F- U L j W U' Q W N O Q 0 m. Li, � ZO U W Z C9 N J J F- Q F- Q 0 Z m W -J O O LL 0 0 _- H Z W F- W F- W W F- _ U 0 o I=i QU' 0 I S J O a QZ R W H>> O SUB BSMT. BASEMENT 15T FLOOR -2W-FLOOR 3RD FLOOR 4 1H FLOOR 5 FLOOR 6 IHFLOOR 7 1HFLOOR 8 FLOOR Check One Only Certificate # Installing Company Name: Eric C. Foster Plumbing & Heating LLC Corporation Address:. 145 Stedman Street City/Town:, Chelmsford State: MA Partnership Business Tel: 978-256-5976Fax: 978-452-4711 i 04-354-2016 Firm/Company Name of Licensed Plumber/Gas Fitter: Eric C. Foster 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 of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Aoent By checking this box ❑; I herebv certify that all of the details and information I have submitted for entered) reaardino this aoolication are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1427 f the neral Laws. -- -1--17-- Type of License: By Plumber Title ✓ Gas Fitter s Signatu a icensr3l /Gas Fitter Master City/Town Journeyman License Number: APPROVED (OFFICE USE ONLY) LP Installer LLJ LL) LU 7-1 uj Lli Lli LLJ Date./-. yc:� ...... 6 /'� rj;;L. TOWN OF NORT'HA4 DOVER PERMIT FOR GAS INSTALLATION This certifies that .(7�r. e5p C. r-. ........... has permission for gas installation ................... in the buildings of ..... ................. at /X i--......... , North Andover, Mass. Fee ... Lic. No. 1.).'i X ... ......�,. ............. GAS INSPECTOR Check# 6091 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) oJQr Mass. City, Town Building AT: Location g0 New ❑ Renovation ❑ Plans Submitted Yes ❑ No Date �� 20 67 Permit # O / Owner's Name t-, LVI:FGitae/ o�c�oa� Type of Occupancy:, -SC" I Replacement[ (Print or type) Check One: Certificate Installing Company Name ce/4- � Coo 1Ih , ❑ Corp. Address rr� /varl-tq rn_s`Qle SFreB'�" �(] Partnership (-)CkrnTad y1- d /8�d/ ❑ Firm/Company I have informed the owner or his agent that I do not have liability insurance, including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. 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 :his application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of t neral Laws. Name of Licensed Plumber �tCAA WE. — C Ry— C -o0 Signature of Licensed Plumber Type of Plumbing License License Number �, Master 0 Journeyman Business Telephone X/ -Q3 12— I ............................ �nnumm�nnu�mum �nnmmmnunmmm (Print or type) Check One: Certificate Installing Company Name ce/4- � Coo 1Ih , ❑ Corp. Address rr� /varl-tq rn_s`Qle SFreB'�" �(] Partnership (-)CkrnTad y1- d /8�d/ ❑ Firm/Company I have informed the owner or his agent that I do not have liability insurance, including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. 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 :his application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of t neral Laws. Name of Licensed Plumber �tCAA WE. — C Ry— C -o0 Signature of Licensed Plumber Type of Plumbing License License Number �, Master 0 Journeyman Business Telephone X/ -Q3 12— i COMMONWEALTH OF MASSACHUSETTS DIVISIONOF R• • IN REGISTERED AS A PLUMBING CORP ISSUES THIS LICENSE TO MICHAEL BERNASCONI CENTRAL COOLING & HEATING INC 68 MOUNTAIN RD Cn BURLINGTON MA 01803-4741 2806 05/01/08 218203 MMONWEALTH OF MASSACHUSE S •TR M- >'LIJMBERS AND GASFITTERS 1. AS A JOURNEYMAN PLUMB t ISSUES THIS LICENSE TO �yEL C BERNASCONI ?UNTAIN ROAD `�!GTON MA 01803-474 1174 05/01/08 255219 �. . y . Commonwealth of Masses usetts ; Division of Registration, \� Board of Plumbing ExaT�_ MICHAEL.'t? 68 MOUfyj'A r' ;1 BURLING'w Master Plumber PL15137-M 05/01/2008 `V=X00600 License No. 4 Expiration Date. Serial No. f COMMONWEALTH OF MASSACHUSETTS DIVISIONOF R• • IN REGISTERED AS A PLUMBING CORP ISSUES THIS LICENSE TO MICHAEL BERNASCONI CENTRAL COOLING & HEATING INC 68 MOUNTAIN RD Cn BURLINGTON MA 01803-4741 2806 05/01/08 218203 MMONWEALTH OF MASSACHUSE S •TR M- >'LIJMBERS AND GASFITTERS 1. AS A JOURNEYMAN PLUMB t ISSUES THIS LICENSE TO �yEL C BERNASCONI ?UNTAIN ROAD `�!GTON MA 01803-474 1174 05/01/08 255219 �. . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Map # lot # 600 Washington Street Address: Boston, MA 02111 Permit # www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle(Business/Organization/Individual): rQo rUQ 111? G rjl./ MA . J --Y? C. Address: v `� City/State/Zip:_ W bkkrd , 1M p�- O/ A / Phone.#: "7F1—x,3,3 Are you an employer? Check the appropriate bog: LN I am a employer with $35 4. El I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. E 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. E We are a corporation and its 3..E 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required):_ 6. E New construction 7. ❑ Remodeling 8. ❑ Demolition 9. E Building addition 10.E Electrical repairs or additions 11.E Plumbing repairs or additions 12.E Roof repairs 13.y Other -3s -,'f e- e— "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeownas who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1contEactors thatcheck this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employee If the sub -contractors have employees, they must provide their workers' comp. policy number. Iam an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name_. G� Abc_\ Policy # or Self -ins. Lic. M Z5_OU 4 i9 G 3 b Expiration Date: I I' 1 do? Job Site Address:_ ?c� City/State/Zip: Na . 6-JdAr 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 tip 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. Ido hereby 1fy undac the pains and pe altles of perjury that the information provided above is true and correct St a Date:& 16 7 Phone #: 'j0'/� J'O' 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 II Contact Person: Phone #: II Date.. TOWN 0yKN TH ANDOVER t PERMIT FOR GAS INSTALLATION This certifies that ......... 7. has permission for gas installation in the buildings of ... .............. at ..-_-PPP ------- ........ ...... S.,,Nrorth Andover, Mass. Fee 7 Lic. No........... G .1 t� �F; �T,61':;4 Check 6107 � 55 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Noah > C1QQy/ Date:%-Jy a �ermit# Building Locatio Owners Name: Z)� . 1 101 G sc he o� Type of Occupancy: CommercialEducationa� Industrial Institutional Residential New: Alteration: Renovation: Replacement: Plans Submitted: Yes No r W - LU 11rl� 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 of coverage by checking the appropriate box below. A liability insurance policy V 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Aaent Owner Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to ine nest OT my Knowieage ana tnat an plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the GWral Laws. By Type of License: Plumber Title ✓ Gas Fitter Signature o Licensed ber/Gas Fitter Master City/Town Journeyman License Number: 9311 APPROVED (OFFICE USE ONLY) LP Installer 1 In 1 VI\LJ N� 1.L w Z < Cn U OV D i O W w N _ IX I--- w z z z 0 W ? p 0 Z n (r a w M0 w a W O Q a 2 O a I - N v V Z 0 O 0 IX V a M IX W > W Z zz M '� cn -� W Q 9 O Z J (� Q m W O z O y 2 W W Z H W W H H_ v o o LL 0 0 z i-1 O Oa z W>> 3 O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 1H FLOOR V5 FLOOR 6 FLOOR 71H FLOOR - 8 FLOOR Check One Only Certificate # Installing Company Name: Eric C. Foster Plumbing & Heating LLC Corporation Address:. 145 Stedman Street City/Town: Chelmsford State: MA Partnership Business Tel: 978-256-5976 Fax: 978-452-4711 04-354-2016 Firm/Company Name of Licensed Plumber/Gas Fitter: Eric C. Foster 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 of coverage by checking the appropriate box below. A liability insurance policy V 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Aaent Owner Agent By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to ine nest OT my Knowieage ana tnat an plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the GWral Laws. By Type of License: Plumber Title ✓ Gas Fitter Signature o Licensed ber/Gas Fitter Master City/Town Journeyman License Number: 9311 APPROVED (OFFICE USE ONLY) LP Installer v 7_ L_ i i C r. = C J N - i _ O v a v 6317 Tt NQRTM 0 :. Date ...... (..`...I.9.`.Q. (. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......................! '. L� T �.......!!�.. ....... ..................... has permission to perform ..........�...t* ............ .. 3.)................... wiring in the building of ........ �..... /C �! L:1........./ka. �..... ;? M.A.A F � lE t' ST /1410 L/t-yzS at.............................................`................................ ,North Andover, Mass. 0 Fee .. 2-5 Lic. No. AI.P... `- &............ d ial ?... ....... r1 ELEcmicAL INSPEcTo$ Check # 3 i A r Commonwealth of Massachusetts Official Use only Permit No. ,� % Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (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 ALI, INFORMATION) Date:lk-rhxl /7 O16 City or Town of:L To the Inspector of Wires: By this application the undersigned gives notice of his or Fer intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant 1<17 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 Location and Nature of Proposed Electrical Work: Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters % Completion o the fir/lowing table may be waived by the tins ector o ff ir•es. 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 ❑In- ❑ rnd. grnd. o. of Emergency Lighting Battery 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 Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems:* No. No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts 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 tf desired, or as required by the lrrspector q/ 6Vires. 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. 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 undersigco vera. certifies that such vera =e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the p tins and pens ies of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.%%� Licensee: � e Signatur LIC. NO.: 113V; (1f applicable, e er mpt" in the tic rse number li e.) Bus. Tel. No. Address: D o`7 lr Alt. Tel. No. *Security System Contractor License required for this work; if applicable, en er 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. Date ........ Of .NO °TN 3= �` TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION .. � ,�9SSAC HUSEtth♦ i -This certifies that ...11e` -./.e. !�/� ! l ............... . has permission for gas installation ....... .. . in the buildings of .. 5. ... ..' ......... .................... . at ... ��r"o ..�!'� / C.0 ............... North Andover, Mass. ZI Fee.. ? .... Lic. No... 3!...'... ....��— "' :...... GAS INSPECTOR Che&# 7 /4 t / i 5413 1- MAI FAASSACHUSETTS UNIFORM APPLf (,-;ATION FOR PERPAfT °�O DO GASFfI` NG �'-g-- - (,Print or T; 4>e) Mass Date % In Permit 3 C�;�iiciinc� location ` ,Q// Owner's iJame '% ► E, j �/� �� - •-- ---------_—_._ � Type of Oc Cuppan"ry-s-ll�.�L!!�____._ New ❑ Renovation ❑ r�epl4 e; ent ,Flans Submitted: }'es❑ N Installing Company Name 1 /tel Address . 3 w ege ,, 6 Business Telephone z Name of Licensed Plumber or. Gas Fitter (51e"90 'Re Check one: Corporation ❑ . Partnership ❑ Firm/Co. Certificate -.��� INSURANCE COVERAGE: I have a cur -re liability insurance policy or its substantial equivalent which meets the requirements of MGI. Ch. 142. Yes' No f-1If you have c ecked yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy4 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: Signature of Owner or Owners Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above app tion are true and urate t he best of my knowledge and that all plumbing work and installations performed under the permit issue s application wil I rice with all..., pertinent provisions of the Massachusetts State .Gas Code and Chap(& 142 of the Gene s. T of License: Pfumber gn ture of licensed Plum r or Gas Fitter Title Gasfitter Master License Number _� j �� z City/Town Journeyman APPROMVED (O IC US . NL 0 Sol son MEN Omni NONE Omni MENNEN Omni 41TH FLOOR -�En ON NMI ON" M.; on 0 NONE MIMIMI soon Monosson on Sol mom■MEN ■MEN ■■■■■■■■■u■■■■■■� Installing Company Name 1 /tel Address . 3 w ege ,, 6 Business Telephone z Name of Licensed Plumber or. Gas Fitter (51e"90 'Re Check one: Corporation ❑ . Partnership ❑ Firm/Co. Certificate -.��� INSURANCE COVERAGE: I have a cur -re liability insurance policy or its substantial equivalent which meets the requirements of MGI. Ch. 142. Yes' No f-1If you have c ecked yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy4 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: Signature of Owner or Owners Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above app tion are true and urate t he best of my knowledge and that all plumbing work and installations performed under the permit issue s application wil I rice with all..., pertinent provisions of the Massachusetts State .Gas Code and Chap(& 142 of the Gene s. T of License: Pfumber gn ture of licensed Plum r or Gas Fitter Title Gasfitter Master License Number _� j �� z City/Town Journeyman APPROMVED (O IC US . NL Date. q-- TOWN OF NORTH ANDOVER 0 :�.-joNkL 0. I PERMIT FOR PLUMBING US This certifies that .4 ............................ has permission to perform .... ...... plumbing in the buildings of ... 5-0/. . 4111r..t. r ............. at. ............. . , North Andover, Mass. 3 Fee. Lic. No./ ....... ........ .. ....... yP'LUM81NG INSPECTOR' Check # 6787 V MASSACHUSETTS UNIFORM APPLICATION FOR PERMtT TO ®O PLUMBING (Print or Typ!a) No -ANS Mass. Date20Pen-nd # 7 / Suliding lx=nuca� /`�� -Owner`s Name 5< 1 C,14e,, UV �r J Type Pf.- lCCJparecj/_ _err^ New ❑ Renovatlon ❑ t Sua—eSMT, BASEMENT 1ST FLOOR 2,40 FLOOR 2R0 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR �)j Installing Company Name—//e ARA Address 7 eol1�-e _3 Business Telephone 77S --o Name of Licensed Plumber C�It��.'1 %✓a e Flans Submitted: Yes ❑ No* Check one: Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I have a curreliability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have c cked yes• 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitt knowledge and that all plumbing work and installations pert er r entered) in above application are and accurate to the best of my pertinent provisions of the Massachusetts State Plumbing Chapte the permit is rthis pli on will be in compliance with all theBY ws Title gna re o cen umber Dty/Town Type of License: Master Journeyman ❑ APPPOWff(O I P1L License Number �, - V x y y Z Y f y N N O Z W = J y Y O < N 0 W H W y ¢ S C y .d y y ¢ W O O C y¢ i< W- A H h W A • J N C !- V < 2 S CL Z S Y d O > 1• O ' N DIY -j m y O O 3:1 x !d- q U. Sua—eSMT, BASEMENT 1ST FLOOR 2,40 FLOOR 2R0 FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR �)j Installing Company Name—//e ARA Address 7 eol1�-e _3 Business Telephone 77S --o Name of Licensed Plumber C�It��.'1 %✓a e Flans Submitted: Yes ❑ No* Check one: Corporation ❑ Partnership ❑ Firm/Co. Certificate INSURANCE COVERAGE: I have a curreliability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have c cked yes• 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitt knowledge and that all plumbing work and installations pert er r entered) in above application are and accurate to the best of my pertinent provisions of the Massachusetts State Plumbing Chapte the permit is rthis pli on will be in compliance with all theBY ws Title gna re o cen umber Dty/Town Type of License: Master Journeyman ❑ APPPOWff(O I P1L License Number �, - V L NO Commonwealth of Massachusetts permit No. ©� — Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS MIP & parcel APPLICATION FOR PERMIT TO PERFORM ELECTRICAL APPL WORK All work to be perfortned in accordance with the Massachusetts Electrical Code (MBG), say 7 CMR la.00 OR TYPE ALL LVORMATI01O Date: (PLEASE PRINT WINK To the Inspector of Fires: City or Town o€: �a�—.,..�,,t,,,en�fthiiaor�herinte�ntiOu�tO B this a lication the �mdersigneiperform � electrical work described below. Y PP � � Location (Street & Number) L G L Telephone Owner or Tenant C> A Owner's Address No C1Building Permit # Is this permit in conjunction with a building permit. Yes Utility Authorization No. purposed Building S G 1-1a d No. of Meters — Exhting Service Amps / Volts Overhead C]Und d il7 ❑ New Service —Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (_ I & / COmDletion of the following table may be waived by the lnsp *c�tI o Wires. ' OTHER Attach additional detail if desired. oras required by the Inspector of Wuses. 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 Q BOND ❑ OTHER ❑ (Specify:) (Expiratton 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. that the information on this application is true and complete. j I cen , under the pains and penalties of pert ty, LIC. NO.: A 11 3 8 3 FIRM NAME: IN is . LIC. NO.: E 2&2 8._8= Licensee: Signature 3 - 54-2 0 LOUIS CONTINO gn11 w—.el.No. 78-�----� (yapplicable, enter "exempt •• in the license number line.) CZ Address: 1 nn �wnu nu WFST NFWRiTRV rrtA 01 98� Alt. Tel. No.• OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage no y required by law. By my signature below, I hereby waive this requirement. I am the (check one owner owner's nt. a e _ __ PERMIT FEE: a F�—K.low L tel` �-261G-o5 0 .(ON 5974 Date. g ............................... at ..... .......... ................. . North Andover, Mass. .............. i ......... FeeA..................... Lic. .ELECTRICAL INSPECTOR Check # k)c� Commonwealth of Massachusetts Department of Fire Services BOARD OF� FIRE PREVENTION REGULATIONS Official Use Only Permit No. V��! Occupancy and Fee Checked [Rev. 11/99] /leave�lilankl APPLICATION FOR PERMIT TO PERFORM ELE All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR T City or Town of: By this application the undersigned Location (Street & Number) Owner or DAL WORK 527 CMR 12.00 L�7/fTo 4he Inspector bf Wires: or 4er intention to perform the electrical work described below. Telephone No. 0 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No PK (Check Appropriate Box) Purpose of Building 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: Comnletinn nfthe fnllowino tnhh, mnv be waiver/ by tha lnenartnr of Whoa 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 AboveElIn- E]o. d, rad. o mergency 1g g Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: NumberTons KW , No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other' Connection No. of Dryers Heating Appliances )[tel Security Systems: No. of Devices or Equi valent ater No. of KW Heaters o. of o. of Si s 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. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof ofliability 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:) 40 (Expiration Date) Estimated Value f Electrical Work: (When required by municipal policy.) Work to Start: L ofo Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the p ns and penalties of perjury, that the information on this application is true and complete FIRM NAME: YL) 1 LIC. NO.: Licensee: AIL — SignatureIC. NO.: (If applicable, enter "exempt" li in the license nttmber e.) %- A Cl $ us. TeL No. Z%�S1� - - l T� CC Address: � Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have Aie liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check ofie) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No.PFFEE: $ . s Date....J../ d�S`...... TOWN OF NORTH ANDOVER CL PERMIT FOR WIRING f ` -This-certifies that...1............................................................... Ahas permission to perform ....................................... wiring in the building of .,-.:�...< ........ .......... , North Andover, Mass. . C_ Fe ..........fois Nom %� ....,�,.......... �t r� ELECTRICAL INSPEcr6i Check # °� a*� Commonwealth of Massachusetts LM7ap&Parcel�— Department of Fire Services gOARD OF FIRE PREVENTION REGULATIONS % h. ION FOR PERMIT TO PERFORM ELE Pr T L ApPLICAT WORK • All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52I CMR 12.00 Date: (PLEASE PRINT IN INK OR TYPE ALL INFO D E2 To the Inspector of Fires. City or Town Of: /���!�%% • application the undersigned gives notice of his or her intention to perform the electrical work desen'bed below. By this PP � p' . Location (Street &Number) L G 0®L Telephone No Owner or Tenant Owner's Address No ❑Building Permit # Is this permit in conjunct wit �llding permit. Yes Utility Authorization No. Purpose of Building .S No. of Meters ExistingService — AMPS / Volts Overhead ❑ Und rd g ❑ —.rd No. of Meters New Service — Amps �-- Volts Overhead ❑ Und g Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1 - Com letton o the ollowtn table ma be waived b theIns� for o Wires. ° No. of Ceil.-Susp. (Paddle) Fans Transformers KVA No. of Recessed Fixtures Generators KVA No. of Lighting Outlets No. of Sot Tuba o. o mergeacy g ng No. of Lighting Fixtures �3 Swimming Pool rnd e ❑ rnd. n.❑ Batte Unita No. of Oil Burners FIRE ALARMS No. of Zones No. of Receptacle Outlets o. o e on an No. of Switches No. of Gas Burners InitiatingDevices 100— No. of Alerting Devices No. of Ranges I No. of Air Cond. Tons P ._.._ _ _ _ . -. T e out n ea um um er ons ctiodAlertin Devices. No. of Waste Disposers Totals: c P [� Other l ❑ S ace/Area Heating KW Connection i No. of Dishwashers P scar ty ystems: No. of Dryers Heating Appliances KW No. of Devices or E uivalent o. o ater KW o. S[ na Ballasts . DataNo. Tome -vices or E uivalent Heaters a ecornrnu ca ons g: . No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent OTHER: Ath additional detail if desired, oras required by the Inspector of ►res• tac 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 `bompleted operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exiubited proof of same to the. permit issuing office. BOND ❑ OTHER ❑ (Specify:) 9 1 7 — CHECK ONE: INSURANCE (Expiration Date) Estimated Value of Electrical Work: (When required by municipal Policy.) Inspections to be requested in accordance with MEC Rule 10, and upon completion. Work to Start: I certify, under the pains and penalties of pedury, that the information on this application is true and complete: LIC. NO.: Al 1 ) 8 3 FIRM NAME: LIC. NO.: E 2 8 7 8 8 Licensee: LOUIS CONT INO Signature Bim, Tel. No. 7 8- 3 6 3-54 2 0 (if applicable, enter "exempt " in the license nwriber line.) Alt. Tel. No. Address: OWNER'S INSURANCE WAIVER: I am awbaretd a lreq�t�nt I amthe(checak one �e cove ownnormally erls allnt. required by law. By my signature below, I be y Owner/Agent Telephone No. PERMIT FEE: a� Cion9ture' Location 06) P L� No.15,8Date zi ,.aR,h TOWN OF NORTH ANDOVER Certificate of Occupancy $ '7s +,^O • Eta Building/Frame Permit Fee $ �► d s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L! Check #- 18338 A �(A0'0 V Building Inspector 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 's Section for ficial Use O�y BUILDING PERNUT NUMBER: /1788 DATE ISSUED: A2 f SIGNATURE: Buildi2& Comnussi2aer/Ins xtor of BmIdings Date .f' 1.1 Property Address- 1.2 Assessors Map and Parcel Number. go-Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUR DING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 54) 1.7 Water S ly M.G.L.C.40. Private Zona Public ail 1.5. FlZone Information: 8 Sewerage Disposal System Outside Flood Zone �/ Mmic' rpat ❑ On Sita Disposal System ❑ 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Authorized Agent KgJ1 J� t Na rint Address for Service: :s 76) to S' ature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Address License Number L Li Con OAU MA ��L'/2 Expiration Date re Telephone 3.2 Registered&6 ic Improvement Contractor Not Applicable ❑ SSA4; Company Name Registration Number ® Q / Add Expiration Dak «� Si lure Telephone M VIN I 0 i M n Z 0 Z M 90 0 r r r Z G) I, k9ul!j,SYh 17 as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name l0 2Z L Signature Owner/ nt D to Item Estimated Cost (Dollars) to be�rnyj wh r Completed by permit applicant �rq ; k� �; "� ���� Yi xr 1. Building (a) Building Permit Fee 1 6 0 C'> Multiplier 2 Electrical �00 (b) Estimated Total Cost of Construction from (6) 3 Plumbing CSO d Building Permit fee (a) a (b) 4 Mechanical (HVAC) G 6) 5 Fire Protection v 6 Total (1+2+3+4+5) Check Number D04 1¢ " r 4 k? w r 91 ,a fi °4 G'k,.h. LSA' <;Tk r. ) "kt..{ 71 C. y((<� 4..• t. Y.�££ .q„Y.P r Y5 .t ,t 1 f 4yfJ Y '�- u.;i:, v£�;: >t 'nz•.:,h�.�,.f�.2$» 3, �,�fttn...ra1. .�-.. ;,,-�•,4.: M< .'14v•.tn .sd �` �.o£.i try ...k ryrJ� it4�. (,. -..}.• ka: ,,<�.s ( lE.� i�,�J�,.. �. .!. ? t,rr .kad 1<.s r�:'1 ,� h., > :r.*5� "7 i.. �.. T.•<: �a�. �i). �7. tr S�x�G f. �: },c, fE -. is ?,,.1 �°iPi..a�...v�}•. � 'ft � ..AT. ni -.,1.1 , tv w. .: ,, -: 1�9 t,4 ''��551:}'V/' .]'.wry ..ti5.. e1.(y. Y..., i fi 7,e. }.., :'�.:' � •. �i.1C. tw 7 �'- i ) P3`Y t. ik a �} xoi✓�.,. ri�ZYi��slj.�,. '}•»'{✓� ��yX fj5 �2{�4 �j :,(�ti�l'�� S.;ti: 1�. 4(h�r1J \.�{rk AS"r�. S�'�i 'T%`:.�'k?...&T,/ '.+'�'��.t L � l� i� .ii).. to ��..i.%"�' �,N. at NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr 2ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIv1NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE iri`'7l`Y^.. a., 4T IN A�3f '�'i' �� . 1�'$ i'i�i�-4 � � �� r �• _ FK� z b - ..� + .. x 4 - Via? ti ,�i'r�fs` - �`d i �z `�v` C � .�� ,,� F'�,\+, v-;q�"'',iC 1'r Y, ,f`+.7-•}kY;- " .3.F• �L �'., t.:,,,.::; Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea ...... No ....... 0 SEi4�,il fi3 GlJ1+iSTIU' 'IRb1L'��Trb��'r�,QQ?it`i17bS''Aj 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility ' Name .>r Registration Number Address Expiration Date Signature Telephone Area of Responsibility . Registration Number Expiration Date Name , Address Signature Telephone �''h `�� � � < • Not Applicable ❑ Com j�iame: 7&,- , r7t r Responsible in Charge of Construction New Construction ❑ Existing Building K Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: Cl 7j 1 dl�!/� CS A> A-2 A-5 - ❑ IA 113 ❑ ❑ B Business BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heieht lftl Structural Structural Peer Review Yes ❑ No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT of the subject property Hereby authorize Key f �, 'S'. d� My behalf, in all matters relative two work authorized by this building permit application to act on Lizo 23 O5- gna er Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A4 0 A-2 A-5 ❑ A-3 ❑ ❑ IA 113 ❑ ❑ B Business ❑ 2A 2B 2C ❑ 0 0 C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B 0 0 IInstitutional ❑ 1-1 ❑ I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Utility M Mixed Use S Special Use 0 ❑ 0 Specify: Specify: 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: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heieht lftl Structural Structural Peer Review Yes ❑ No 0 SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT of the subject property Hereby authorize Key f �, 'S'. d� My behalf, in all matters relative two work authorized by this building permit application to act on Lizo 23 O5- gna er Date r , 1 .y....., .11. 1. . UA J h =3 =31 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. APPLICANT FILLS OUT THIS ECTION j'D ,�j -7 APPLICANT S�� �I ��D� PHONE�� ! ! 0 LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET AAALv ST. NUMBER eQ OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS 1 PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT- DUMPSTER PERMIT Qr,w I e -p j /d Ore hl-/" f; iY RECEIVED BY BUILDING INSPECTOR DATE FORM U - Revised 6.08 JMC e(Axl')� TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED 1 PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT- DUMPSTER PERMIT Qr,w I e -p j /d Ore hl-/" f; iY RECEIVED BY BUILDING INSPECTOR DATE FORM U - Revised 6.08 JMC e(Axl')� i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR I Number CS 001724 BIrWite: ,03/05/1956 Expire 03/05/2006 Tr: no: 17529 Restricfed OD:.�� -� . KEVIN J SMITH �} 110 HIGH STREET , a N ANDOVER, MA 01845 z Acting QVhmistooner fe eoarninuuea a�;/�iaooac�ivae%ta Board of Building Regulations and Standards SMITH CON Kevi,;is'Smith 110 High St N Andover, P NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: go A4,o(4 ke—, j1v_ A!,&Vs 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: Fire Department Sign off. Dumpster Permit (Location of Facility) ature of Permit Applicant z, bo 5� Date 1 ne Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: su~i'A Are you an employer? Check the appropriate bog: 1. E�'I am a employer with __L- 4. ❑ I 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. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' camp. insurance required.] *A— —...1:.. Type of project (required): 6. ❑ New construction 7. R^Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other --+—rr•---••• •••^• —•• Q. a ......,, a,�., .,,, qui uic secnon oeiow snowing their workers' compensation policy information.• thi t Homeowners who submit s affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such lContractors 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: C Policy # or Self -ins. Lic. #: / %b p(�� y p/ z��C Expiration Date:_4& 7o& Job Site Address:_ 60 AA" A/Q, City/State/Zip:_422_4 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 --76 & penalties of perjury that the information provided above is true and correct r Oficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employers: 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 enterprise, and including the legal representatives of a deceased employer, or the of the foregoing engages in a Joint enterp � to employees. receiver or trustee of ab individual, partnership, association or other legal entity, employing mp yees. However the owner of a dwelling house having not more than three apamaintenanents ce, on suchaor the dwelling house of the dwelling house of another who employs persons to do 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 operate a business or to construct buildings in the commonwealth for any renewal of a license or permit to 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,hone numchecking along withe boxes th thein ertificate(s) of y to your nand, if necessary, supply sub-contractor(s) name(s), address(es) a p 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 vsure to e submitted n and date the affidthe a of nt of tri Accidents for confirmation of insurance coverage. Also g be returned to the city or town that the application for the arermit the law or if you aor license is re required �to obtain anot the workers' at of Industrial Accidents. Should you have any questions regarding compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an app licant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in , (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would lice 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 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia YI m x m m m y v m y tp Z � O CLCL acc o p a� Q� CD O d O to CD CA CD O C= y d d O COD O y d CD CD CD y CD 0 CD 3 CD O c w o cr = ME Qa m y Eggs m Z m- �� a �W= Sm �° T �. a •+ a o 40 m m o y a Polo IF m = > >mvi 3 a IS 1 A, rr Z C/)mm ° C ' n co n O _ F � zy amccr U, o -cc" - a y wpm �• VJ N O y S � i, 3y-.46 o =�mr.Z O ooh O zIF a to Oqrb Com" 1=0 Or : 0 Imwo N = ; ob 71b: = �. ME. . . .J omq z V q�. r acp OCA omq TO DATE TIME AM PM P FROMy PHONE( ) H CELL ( ) O OFA FAX ( ) N E M E` s 17 E a M E 0 E-MAILADDRESS SIGNED PHONED ❑ CALL ❑ RETURNED ❑ ❑ WILL CALL 0 WAS IN ❑ URGENT ❑ SEE YOUO Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director January 21, 1998 Mr. Angelo Petrozzelli Design Partnership Architects 3 Washington Square, Suite 400 Haverhill, MA 01830-6139 30 School Street North Andover, Massachusetts 01845 Re: St. Michael's School and Church - Site Plan Review Dear Mr. Petrozzelli, Thank you for appearing before the Planning Board last night to discuss the site plan review application for the proposed expansion of the St. Michael's School and Church. The Board was pleased with the plans as presented however there are a few issues that remain. 1. Need written confirmation from the Building Inspector that the number of parking spaces proposed is adequate. 2. The chain-link sliding gate proposed for the center of the school parking lot is to be removed. A less intrusive method of keeping the children within the proposed play area is to be provided. The Planning Board will grant a waiver from the requirement of providing planted parking lot islands as required by the ,Zoning Bylaw in that portion of the school parking lot to be used as a play area. The other parking areas are to contain islands as required. 4. A construction sequence must be provided with specific details provided as to the how the children will be protected from the construction site. 5. Need written confirmation from the Fire Chief and Police Chief regarding the design and location of the proposed pedestrian walkway and traffic light proposed for Main Street. 6. Need to provide sufficient information to the Department of Public Works to allow them to complete their review of the storm water management and utilities proposed for the site. The Planning Board continued the public hearing on this application until February 3, 1998 with the hopes that all issues will be resolved and the Board may render a decision that night. The additional information must be provided to the Planning Department by 4:00 p.m. on Thursday January 29te so that it can be incorporated into the Planning Board packets. If you have any questions please do not hesitate to call me at 688-9535. Very truly yours, Kathleen Bradley Colwell t Town Planner cc. R_ Rowen, Chairman Planning Board BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 '\ Nicetta,.Building Inspector _ Chief Dolan, Fire Department Chief Stanley, Police Department Father Paul Keyes Town of North Andover NORTN OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street North Andover, Massachusetts 01845 N'tA1,, WILLIAM J. SCOTT 9ssACNuset Director Memorandum To: Kathleen Bradley Colwell, Town Planner From: obert Nicetta, Building Commissioner Date: February 3, 1998 Re: Parking requirement - new St. Michael Church & School I have reviewed the drawings and site plan for the referred location and find that adequate parking exists for both the new church and school facility. As per the following breakdown: Church Required 1100 seats (1 space per 4 seats) 275 spaces School Gymnasium 500 seats (1 space for 4 seats) = 125 spaces Total 400 spaces Provided 286 spaces 150 spaces 436 spaces BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 - Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director Memorandum To: Kathleen Bradley Colwell, Town Planner From: obert Nicetta, Building Commissioner Date: February 3, 1998 Re: Parking requirement - new St. Michael Church & School I have reviewed the drawings and site plan for the referred location and find that adequate parking exists for both the new church and school facility. As per the following breakdown: Church Required 1100 seats (I space per 4 seats) 275 spaces School Gymnasium 500 seats (1 space for 4 seats) = 125 spaces Total 400 spaces Provided 286 spaces 150 spaces 436 spaces BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover t NORTN OFFICE OF 3? ° .'"• ` �< COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street •,� 9> North Andover, Massachusetts 01845 °�.,,,, �:•` WILLIAM J. SCOTT 9SSACNUSEt Director Memorandum To: Kathleen Bradley Colwell, Town Planner Obert Nicetta Building i From. � 9 Commissioner Date: February 3, 1998 Re: Parking requirement - new St. Michael Church & School I have reviewed the drawings and site plan for the referred location and find that adequate parking exists for both the new church and school facility. As per the following breakdown: Church Required 1100 seats (1 space per 4 seats) 275 spaces School Gymnasium 500 seats (1 space for 4 seats) = 125 spaces Total 400 spaces Provided 286 spaces 150 spaces 436 spaces BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NO Town of North Andover of,NO o* "�a OFFICE OF �� ,• •. COMMUNITY DEVELOPMENT AND SERVICES ° . 146 Main Street �o North Andover, Massachusetts 01845 WILLIAM J. SCOTT �ss�CHUSEt Director Memorandum To: Kathleen Bradley Colwell, Town Planner From: obert Nicetta, Building Commissioner Date: February 3, 1998 Re: Parking requirement - new St. Michael Church & School I have reviewed the drawings and site plan for the referred location and find that adequate parking exists for both the new church and school facility. As per the following breakdown: Church Required Provided 1100 seats (I space per 4 seats) 275 spaces 286 spaces School Gymnasium 500 seats (1 space for 4 seats) = 125 spaces 150 spaces Total 400 spaces 436 spaces BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 689-9535 ign " ArchitectsInc. DesPartners Three Washington. Square Suite 400 Haverhill, MA 01830-6139 508.372.9400 Fa --x 508.37306779 I l i February 5, 1998 Archdiocese of Boston 2121 Commonwealth Avenue Brighton, MA. 02135 Att: Mr. Peter Forte Re: St. Michael's Parish/School North Andover, MA. 01845 D. P. A. Project No. R95-9-126 Dear Mr. Forte, Design Partnership Architects, Inc., in response to your concerns, is forwarding all plans listed in the enclosed transmittal, including plans dated up to and including plans dated 02-04-98 as well as a Building Code Summary. All of the before mentioned is in connection to the work to be performed at the above referenced location. Please look over these materials carefully. Please note that the Building Code Summary lists the above referenced building as "Type B" construction, Unprotected. It is Design Partnership Architects, Inc.'s intention to use a combination of Metal Stud Partitions and Steel Columns in the basement level of the building and wood framed floors. It is also our intention to have the sprinkler & fire alarm systems in the existing building brought up to code and to have both the fire and sprinkler systems in the new building meet all fire codes as well. Design Partnership Architects, Inc. expects to hear you within seven working days, should we not hear from you we shall assume that all information provided was found to be acceptable. Should yoki have any questions or comments, please feel free to phone our office. submitted, ARCHITECTS, INC. Ili, President AIA/NCARB Enclosure CC: David Jones Richard White Sons, Inc. Father Paul T. Keyes Pat Siatta . Bob Nicetta file AP/ka/stmich.cm2 PRINCIPAL • ANGELO PETROZZELLI • AMERICAN INSTITUTE OF ARCHITECTS k* Design PartnershipArchitects Inc. Three Washington Square - Suite 400 Haverhill, MA 01830-6139 978*372*9400 Fax:978*373*6779 TRANSMITTAL DATE: February 5, 1998 JOB #R95-9-126 ATT: Peter Forte RE: St. Michael's Parish/School TO: Archdiocese of Boston 2121 Commonwealth Avenue Brighton, MA. GENTLEMEN: We are sending you: _Shop Drawings X Prints _Plans _Samples Specifications X Copy of letter _Change Color COPIES DATE NO. DESCRIPTION 1 NO DATE NO # CHURCH CURRENT SCHEMATICS (PERSPECTIVE 1-98) 1 12-18-97 A-1 FLOOR PLAN (CHURCH) 1 12-18-97 A-2 MEZZANINE PLAN (CHURCH) 1 12-18-97 A-3 SECTIONS (CHURCH) 1 12-18-97 A-5 ELEVATIONS 1 12718-97 A-5 SECTIONS 1 NO DATE PERSPECTIVE CONSTRUCTION DOCUMENTS PROGRESS SET (2-4-98) 1 NO DATE SITE PLAN OF LAND IN NORTH ANDOVER, MA. (ANDOVER CONSULTANTS, INC. 1 12-18-97 X-1 SITE PLAN 1 NO DATE A-1 BASEMENT/FOUNDATION PLAN 1 NO DATE A-2 FIRST FLOOR PLAN 1 NO DATE A-3 SECOND FLOOR PLAN 1 NO DATE A-4 SECTION 1 No A-5 No TITLE DATE 1 No A-6 SECTION ELEVATION DATE 1 NO A-7 WALL SECTIONS DATE 1 No A-8 WALL SECTIONS DATE 1 No A-9 No TITLE DATE 1 No A-10 No TITLE DATE 1 NO NO # INTERIOR ELEVATIONS DATE 1 NO NO # BASEMENT FLOOR REFLECTED CEILING PLAN DATE 1 No NO # FIRST FLOOR REFLECTED CEILING PLAN DATE 1 NO NO # SECOND FLOOR REFLECTED CEILING PLAN DATE 1 NO NO # FIRST FLOOR FRAMING PLAN DATE 1 NO NO # SECOND FLOOR FRAMING PLAN DATE 1 NO NO # ROOF FRAMING PLAN DATE 1 NO H-1 BASEMENT/FOUNDATION PLAN DATE 1 NO H-2 FIRST FLOOR PLAN DATE 1 NO H-3 SECOND FLOOR PLAN DATE 1 12-5-96 T-1 SCHOOL STUDIES 1 10-22-97 No # SITE PLAN 1 12-18-97 X-2 LANDSCAPING SITE PLAN 1 10-15-96 No # No TITLE 1 No NO # SCHOOL DATE 1 11-27-96 No # SCHOOL ADDITION 1 11-27-96 S-1 SITE PLAN 1 No No # SCHOOL DATE I No DATE Nog No TITLE 1 No DATE No # No TITLE 1 08-06-97 A-2 No TITLE 1 10-22-97 No # No TITLE 1 No DATE No # SCHOOL 1 No DATE No # SCHOOL 1 10-22-97 No # No TITLE 1 10-22-97 No # No TITLE 1 11-05-97 No # FIRST FLOOR PLAN 1 08-06-97 A-1 NO TITLE 1 No DATE No # No TITLE 1 12-18-97 A-2 FLOOR PLAN 1 11-07-97 A-2 FLOOR PLANS 1 12-18-97 A-1 FLOOR PLAN -ELEVATION 1 11-07-97 A-1 PLAN/ELEVATION 1 11-06-97 A-3 PLANS/SECTION/ELEVATION 1 02-05-98 NO # BUILDING CODE SUMMARY *These are transmitted as checked below: _For Approval X As requested X For review and comment For Bids Due Approved as submitted _Approved as noted Returned for corrections REMARKS: Please initial next to each line item as proof Partnership Architects, Inc. hears different from you with assume that all drawings listed above are acceptable. COPY TO SIGNED _Resubmit _copies for approval _Submit copies for distribution Return_ corrected prints ipt. Also, unless Design working days, we shall Dexsign Partnership Architects Inc. Three Washington Square Suite 400 Haverhill, MA 01830-6139 978*372*9400 Fax: 978*373*6779 BUILDING CODE SUMMARY Massachusetts State Building Code 780 CMR (Sixth Edition) Name of Project: ST. MICHAEL'S SCHOOL Address of Project: North Andover, MA Proposed Use: Parish School ( Educational) Contact Person: Angelo Petrozzelli Telephone #: 978-372-9400 Date: 2/4/98 . A. Building Data: 1. Occupancy Classification: Use Group — E ( Educational) 2. Mixed Occupancy: N (No) 3. Construction Type: 5B 4. Mixed Construction: Y (Yes) 5. Sprinkler: Y (Yes) N.F.i.P.A. 13 6. 7. Fire District: Building Height: N (No) Provided 36 feet < 40 feet Allowable 2. Fre walls/ Party walls: Provided 2 story < 2 story Allowable 8. Building Area: First Floor. 16000 s.f. (existing) Fre Separation Assemblies: First Floor 14800 s.f. (addition) UL#U305 Total: 30800 s.f. provided < 43200 s.f. allowable 1 1 1 Second Floor. 1.3407 s.f. (addition) b. Shafts/ Hoistways: Basement: 11011 s.f. (addition) Area Increase: Total Gross Building Y (Yes) Area: 39218 s.f. (Addition including Basement) c. Mixed use: N/A 55218 s.f. (including existing building) (Note A) (Note B) B. Fire Resistance Ratings (Table 602): Required Hrly Provided Classification Note 1. Exterior Walls: 0 a. Load bearing: 0 b. Non -load bearing: 0 0 2. Fre walls/ Party walls: NIA 3. Fre Separation Assemblies: 1 UL#U305 a. Fre Enclosure Exits: 1 1 1 UL#U305 b. Shafts/ Hoistways: c. Mixed use: N/A d. Other. N/A 4. Smoke Partitions: a. Exit Access Corridors: 1 1 UL#U305 b. Tenant Space Separation: N/A 5. Dwelling Unit Separation: N/A 1 UL#U305 6. Smoke barriers: 1 7. Other non -load bearing partitions: 0 0 9. Interior load bearing partitions, Columns, girders, trusses a. Supporting more than one floor. 0 0 b. Supporting one floor or roof: 0 0 9. Struct. members supporting wall: 0 0 10. Floor Construction / Beams: 0 0 11. Roof Construction: 0 0 C. Life Safety Systems: 1. Emergency Lighting: Y (Yes) PRINCIPAL * ANGELO PETROZZELLI C -%MERICAN INSTITUTE OF :ARCHITECTS 2. Exit Signs: Y (Yes) 3. Fire Alarm: Y (Yes) 4. Panic Hardware: Y (Yes) 5. Sprinkler. Y (Yes) (Note D) 6. Standpipe: N (No) (Note E) D. Exit Requirements: 1. Minimum number of Exits required: 4 2. Number of Exits provided: 7 3. Travel Distance: 150 ft. < 250 ft. allowable (Table 1006.5) 4. Dead end limit: 20 feet allowable E. Occupancy Load: Floor Area Allowances (Table 1008.1.2): Stor/ Mech.: 300 sf. Business: 100 sf. Classroom: 20 sf. net Assembly: 15 sf. 1. Second Floor: a. Stor./ Mech.: 810 sf./ 300 sf. = 3 occupants b. Business areas: 1830 sf./ 100 sf. = 18 occupants c. Classroom areas: 700 x 7= 4900 sf./ 20 sf. = 245 occupants Total: 266 occupants 2. First Floor. a. Stor./ Mech.: b. Business areas: c. Classroom areas: d. Auditorium: 3. Basement: e. Stor./ Mech.: 3000sf./ 300 sf. 10 occupants 750 sf./ 100 sf. = 8 occupants 700 x 14= 4900 sf./ 20 sf. = 490 occupants 3690 sf/ 15 sf = 246 occupants Total:. 754 occupants 11011 sf./ 300 sf. = 38 occupants Total: 1058 occupants Total Building Occupants: 1058 F. Capacity of Egress Width ( with fire suppression system): 1. Doors and corridors: Area Occupants Required Min. a. Second Floor(doors) 266 x.15 40 inches (corrid) 266 x.15= 40 72 inches (stairway) 266 x .2 54 inches b. First Floor (doors) 1020 x.15 153 inches (corrid) 1020 x.15 153 inches Tot2Ll Occupants 1058 x .15 159 inches G. Design Loads: 1. Minimum Roof Live Load: 20 psf (flat) 16 psf (pitched 4:12) 2. Wind Load: 21 psf Zone: 3 Exposure: B 3. Snow Load: 30 psf Zone: 2 4. Floor Live Loads: a. Classrooms: 50 psf c. Offices: 50 psf b. Corridors: 80 psf 5. Presumptive Soil Bearing Capacity: 4000 psf. CODE REVIEW NOTES: Provided 72 inches 96 inches 88 inches 396 inches 192 inches 396 inches A) Table 503: 1 St/ 20 feet allowable height increased 1 story/ 20 feet per 504.2 when equipped with automatic sprinkler system. Section 504.3 allows auditoriums of Type 5B to be increased in height to 45 feet B) Table 503: Allowable area 7200 s.f. increased per 506.2 Street Frontage increase ( or 30 feet open space) if the building has more than 25% fronting on a street or open space, then the Table 503 requirement may be increased of 2% for each 1 % excess, therefore; 50% (fronting on open space) X 2% =100% increase or 7200 s -f. + 7200 =14400 sf allowable Section 506.3 Allows one and two story buildings equipped with automatic sprinkler system to be increased an additional 200%, therefore; 14400 sf X 200% = 28800 sf + 14400 sf = 43200 sf allowable area > 29000 sf existing C) Section 1014.11- Interior stair enclosures for Use Group E connecting less than 4 storys shall be enclosed by 1 -hour fire rated assemblies. D) Section 904.2 Use Group E > 12000sf requires sprinkler system. 904.8 Windowless story, (basement) requires sprinkler system. E) Section 914.2.3- Use Group E when 3 or more storys requires standpipe: END OF REVIEW 3991 �..Date ......... ..... .... ' NowrM or°;•��`' TOWN OF NORTH ANDOVER '° PERMIT FOR WIRING This certifies that ...........�. . W J has permission to perform............................................................U `{t .. J wiring in the building of J f //�'.. ....../...................................................... �( . , North Andov r S. at ............................................,-- ..�................ Fee..................... Lic. No............................................................... +' ELECTRIC763 AL INSPECTOR Check # The Commonwealth of Mas achusetts 01Mce Use ? lr Department of Public .Safety ►tt.tr w,. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200' o�cup.n<r 4, red chtckto ]/90 (leave blank) PPLICATION FORPERMIT Ta. PER 111 %mrk to be performed in accordance with the Mawchu:etu R M,, ELECTRICAL Code.ECTR 7 CMR i CA L WOR K (PLEASE PRINT IN INK OR TYPE ALL INFORi=ION Date � ©� City or Town of 6p +,off, . The undersignedTo the Inspector of fires: applies for a permit to ,perform .the_elect� rical work described below, Location (Street b Number) O m/- -1 Owner or Tenant�ya,'��, S OWner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Aleck Appropriate Box) Purpose of B4Jlifiha ,....�..r..,...,.T.UWity Au'alortgall on NO. Existing Service Amps / Volts Overhead ❑ Und d gr ❑ No. of Meters New Service _fps / Volts Overhead ❑ Undgrd ❑ No. of deters Number of Feeders and Ampacity 414cation and Nature of Proposed Electrical Work f0. of Lighting Outlets Ne. Qf righting Fiauvres No. of Receptacle Outlets No. of Switch Outlets ------------- No. of Ranges No. of Disposals No, of Dishwashers No. of Dryers No. of Water Beaters No. Hydro Massage Tubs =MR. KW No. of Hot.Tubs Swiming pool ADQVG~ ..Int grnd. ❑ grnd No. of Oil Burners No. of Gas Burners No. of Transformers Tota: ® Generators y RVA No: of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of Air Cond. Total tons No. of Detection and No. of Heat Total Total Initiating Devices s PumnKW No. of Sounding Devices ; Space/Area Heating KW No. of Self Contained Detection/Sounding Devices Heating Devices KW Local ❑ Municipal ❑th ConnectionOel No of o. o Si ns Ballasts _ Low Voltage Wirine No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws .1' have a current. Liability Insurance Policy including Completed Operations Coverage or is substantial equivalent. YE NO [f I have submitted valid proof of same to this office: YE If you have ch cke "YES, please indicate the type of coverage by checking the appropriate boxQ INSURANCE BOND 1 /� ❑ OTtIER ❑ (Please Specify) Estimated Value of Electrical Work S�� � D O p =aclon 6a;eT Vork to .Start �� V . r Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME �� tom. 'f7 zlvljlL,C�tLt�� `�i6 LIC. NO�� Licensee .W ' 13 [Za—an�) Signatur _ Address�7` l �c`� STgj�,, nn LIC. N0: " Bus. Tel. No. - j OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the. insurance coverage or its sub- stantial equivalent as -required by Massachusetts Generalws, and chat my signature on this application waives this requirement. Owner Agent (Please check on permit 0 Date. �/-..� % :.U.1- TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............... . r - has permission to perform ..... ............................ . plumbing in the buildings of ....l?r ! 1' c ...S.l-'.C.. . at .. S.G.... �Nf°� �` .. /. LL........._.. , North Andover, Mass. Fee/. �`.' � . Lic. No..9."0 r .. ...... ..... *-*.'?-....... PLUMBING INSPECTOR Check It 16' 3 J- 5210 21MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) . 0 I 11 Au nye Mass. Date / -o .2 0 0. Permit # Building LocationSr r m rcA e- nL_ Owner's Name Type --of Occupancy f J New ❑ Renovation Iff Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES B.P. # SEWER # l-' SEPTIC # r r • . u SUB-BSMT. son 0M_W=LTIQ mom MEMO 0 ENO 2ND FLOOR mom N mom M MONO mom No No MENEM No OMEN MONO mom 0 MEN • • ' ■ON■®MEMON MESMO®M 0 ENO •i- ®M■■■■®OMM®EM®®■®■M M MEN mom Installing Company Name APOLLO PLG & HTG INC Check one: Certificate # Address 1SHATTUCK ST PO BOX 466 NJ Corporation 1097C LAWRENCE, MA 01842-0966 ❑ Partnership Business Telephone 978-688-1755 ❑ Firm/Co. Name of Licensed Plumber DONALD DESRUISSEAUX 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. KI 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: Signature of owner or Owner's Agent 'owner- Agent -❑ nereoy cemty mat aii or me aetatis ana 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 installation performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Generri.kaws. By Title Cityrrown APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Type of License: Master X7 Journeyman ❑ License Number 8699 0-- Id, d z n r z N M m 0 0 z N N m n R V m Io Io r0 m r � D c 4 f- z m 0 o m � O D m O z m z m O O m 0 ={ 0 � to I -c z n r z N M m 0 0 z N N m n R V m Io r0 2 r n c r f- z o m � O „ m O m z m O O 0 ={ 0 � m -c O -� r t' c m 0 t' CO z r . � d z c� Y z n r z N M m 0 0 z N N m n R I 0 V m 0 c� m N N Z N T m n -i 0 z V m Io m 0 0 f- z o m � O „ m O T z m O O ={ 0 � m r t' c I 0 V m 0 c� m N N Z N T m n -i 0 z No 2822 Date..... ... ... .... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ....... L, — "J, e d5 L::- �,O� This certifies that .. .�j ............................................. (n.A .... ( ..... 'hes permission to perform ..... -/� /q.. .... /P /P .......... ................ ................. -wiring in the building of ... 3. r( 9-0 at ............ M .... . . v -&-4,k ........... ... ........ . NoA Andover,,Mass. Fee._. ..... Lic ..... ........... ..... C7R1CAL1;wP*i R,—*----* Check # /(* WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Ccconsnsonwealth o�l�a.e�actiuea� 1J¢Parfnren� o��ira �arvice3 BOARD OF FIRE PREVENTION REGULATIONS Official Usc Only Permit No. Occupancy and Fee Checked _ rev- 11:991 {leave b1nn11 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfornud in accordance with the Mass chusctts Electrical Code (NIEC), 527 CXIR 12.00 (PLEASE PRINT hV INK OR TYPL• .ILL hVI-01 1.-I TIOtV) Datc - ll City or Town of: X1171 To the liishectoi• of, Wires: By this application the undersigned gives notice of his or her intention to perform the electr_ica} work described below. Location (Street ,C Nutftbcr) 6 /�/ x,!57 �UE Owner or Tenant/Z S Telephone. -No. Owner's Address ��6_� Is this perni%t in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building 57CAUL UtiIily Authorization No. Existing Service Amps / faits Overhead ❑ Undgrd ❑ No. of Meters . New Service Amps / : Volts Overhead ❑ Undgrd ❑ No. of.Nleters. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:l l .; C'orr,�lPfinn n�rlro r.,/1.,,.•;,.,, .,.�r_ .. . r._ _ , a No. of Recessed Fixtures --' - - - -• ---- — .....z';.0. INo. of Ceii.-Susp. (Paddle) Fans OI"V VC rnul cri ocurcr'TO2al n of iv:res. No.of Mz1 Transformers KV No. of Lighting Outlets INo. orIIut Tubs Generators KNIA No. of Lighting Fixtures Sti�in:tminQ Pool Above In I ❑ ❑1o grnd. . of Emergency tattUn bQ ttery Units roe of Receptacle Outlets INo. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches INo. of Gas Burners �No, Detection and In Initiating Devices No. of Ranges INo. of Air Cond. TorsTotai Ilio• of Alerting Devices Noof Waste Disposers Heat Puna slumber funs J iC1V i IDetection/Alerting No. of Self -Contained Totals I Devices No. of Dislrn•ashers ISpace/Area Heating Kai' Local ❑ bluuicipal El Other Connection No. of Dryers lHeating Appliances Kiy Security Systems: of Devices or E uivnlent No. of `Vater itlo. ICsV of No. of Data ata i'r'irin Heaters I Siens Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs INTO. of lotors Total HP (Telecommunications Wiring: No. of Devices or Equivalent OTHER: '4uCc I cddit;onol detcil if des.,red, or cs required 5y the intspec.or of I' ir:s. INSUR I CE COVERAGE: unless waived by the ow-ner, no pertnit for the performance of electrical work may issue unless the license-, provides proof of liability uisuraticc including "completed operation" coverage oras substantial equivalent. 11:e undersi2ncd certifies that such coverage is in force, and has exlIibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (expiration Date) (When required by municipal policy.) Estimated Value of Electrical Work- Work to Start: Inspections to be requested in accordance tivith MEC Rule 10, and upon cornoletion. I ccrtifj, under the pains and penalties vjnerjury, that the l r ornration on this application is true and complete. FI Rtl I NAI4 t C/1 "- �• -� C .o — �� LIC. IN O. 9 % ? Licensee:'fJ�'ri�� P • /,.lis-ie� 3. Signature _� �.�'.= LI C. ir0.• (if applicoble, enter "eccnipt " in the licerue ruMber lirre.) Bus. Tel. No..%el, '" Address: % ✓_. o M'� /U, L vr� L" ✓ 2�' jl Alt. Tel. No.: OWNER'S INSURANI CE WAIVER: I am aware that the Licersee does not havethe liability insurance coverage normally / fequired by law. By :ny signature below, I hereby waive [his requirement. I am the (check onc) ❑ owner ❑ o«•ner's zgen . Owncr/Agent Signature Telephone No. PiRtlflT FLL: S- ; 3 Design Partnership Architects Inc. Three Washington Square - Suite 400 Haverhill, MA 01830-6139 978*372*9400 Fax:978*373*6779 DATE: January 21, 1998 ATT: Bob Nicetta TRANSMITTAL JOB #R95-9-126 RE: St. Michael's Parish TO: North Andover Building Department 146 Main Street North Andover, MA. 01845 GENTLEMEN: We are sending you: _Shop Drawings X Prints _Plans _Samples _Specifications _Copy of letter _Change Color COPIES DATE NO. DESCRIPTION 1 12-18-97 X-1 SITE PLAN i nese are transmitted as cnecKea below: For Approval Approved as submitted As requested Approved as noted For review and _Returned for corrections comment For Bids Due REMARKS: COPY TO - I:, ; ,- i? ?t Iir t _ SIGNED JAO 2 21x98 r Resubmit _copies for approval _Submit copies for distribution Return_ corrected prints AIA/NCARB