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HomeMy WebLinkAboutMiscellaneous - 800 TURNPIKE STREET 4/30/2018 (3)N O co CD O C � :t1 Ob z A � M o CD o M O m o m Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. fiL// �. zJo Y� MA - 61 Map_ Phone: � 1- � -) L Email jr�p aa( Nature of Business Do you own this property? Yes No l/ If no, written permission is required from your landlord. Will you have clients coming to this property? Yes /—' No Will you have any employees? Yes No Will you have any major deliveries? Yes Not�/_ Description of Business Activity (Must be Completed) ��U-kD ons Colo c'9:xs ���1 fie - Signature of Applicant -� For Signage Refer to North Andover Zoning Bylaw Section 6 The propos Ji owed e in this zoning district.Issued B ate 0:F North Andover MIMAP May 17, 2017 ... 10001#45. r ?i..:.. s�l #,55; #65 -0918'04,00b 098, 8=0093 0039' X098 0066 :` #676 r •'`--' #676#6 R 098:B-.0063 098:6-0.062 9846- 0064 - - - 0064 09'481D`'`0038�- �.. 098'6=0065,, 8:6-00.6 %=' r t::: `•-•:_. t: (09' .'8-006 .: Cllr •: !! -• ..tlti .: #t .�..OJ it .,:--. '" �y; •t r•i i • �I,�i 098:B-0046" #211 alr ._ 098.1-0047 _:.?? "'"-_:_?�(!� ':: #600? 098;8-0045 #207 #2.14 09\0047 0988�D 00.,4`6 - -' #790 #790 #790#790 098:6=0048 #210 #199 098.6-004,4 #790#790 R2#2o; #790 #790 098.6 0043 #187 #.19,4 /_ "' #790 �� ` #17, , s� 8:6,-0042 09 9a.D-0069 #733 ' '== :i; •=" #790 7\t /#•186:, �'•.?�1!r:-::: #733 #733 _..5 098:6=004.3 #733 ::.__ - '0', 178. ani :.-.:: #800 �° 114 = 1S 098B.-0040 #800#800 098;D-0008 #800 +#1°7 Q9$;,6,-0039 GB #800 #800 098.1-0045 #757'it "•=• '••- #820 98.D-0052 ""'= #820 #75 7 098.1-0009��� x'; #820 #785 :. •: \�' \\ #700098.B-00951-- #820 #120098.D-0053 089-793 #820A 098:8=0009 #820a #710 92 #795 (098;6.001 l2: #795 o� 098.1-0044 #799Ro?a` #sis #100 #815 #815 �0F #799-, 098.D-0050 ;#25- 098.D-0054 I 1 #860 107:0.011.1 #811 #809 #807 098..1; 00.42 107.0-0721 #865#871 098._1-0018 #863 #60 #869 107.0-0074 #861 625.0-0078 #30#30 #859 #867 0 MVPC Bo Zoning Overlay Zoning (3 Municipal Boundary © Adult Entertainment Distric . Businei 0 Machine Shop Village Ove O Busfirei s 1 District s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — Rail Line 2 Watershed Protection Dist O Businei Interstates 0 Historic Mill Area ■ Busine Interstate 0 Medical Marijuana ■ Genera Major Road O Downtown Overlay District O Planne 0 Historic District :: Cortid s 3 District s 4 District Commercial Devtt�r�• Development Dist Business Districtr4L'% NORT►M q O1 pOEnvironmental Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of The information depicted on this map is 0 Osgood Smart Growth (40 O Cortid t r Easements CC Hydrographic Features O Comid Development Dist Development Dist L • � " � � rposes only. IIS. for tanninRoads p g purposes only. r may not H adequate for legal boundary defnition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Industri Parcels Streams .^. Industri I 1 District 12District w THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Y Wetlands O Industri 13 Ind 3 DisMct S District i u ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Exempt Lands Reside ce 1 District �1 , o����n '���j THIS INFORMATION :: Reside ce 2 District SSACMUS� O Reside ce 3 Dishi l de 1" = 253 ft"d }rde e 4 District ce s District de ce 6 District .o a esidential District jdN Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Applicant. Name: ° n ( �07` Name of Business: G 1 7-Y Address of Business: 5R00 - U/l ly f l a F Sr Zoning District : —1 A 51, 1 i 300 Map ©a� Lot Phone: L goo _TS a0`� EmailG' %7`t. S� Co�-Tr N @ 6r"4-1 L • Co VL4 Nature of Business: S�En2 Co a ti G C sL n z CG s n` L-6 L S rn P 5 IS 6UP A01'gt'v c,(�cCc- Do you own this property? Yes No If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No Description of Business Activity (Must be Completed) '1—(65 IS 01Jc1 A-PVhiN 0 � C E , t,) �— CALL CLf fA/TS A`0 SF .11' civ v" (7-�' I w 0 ;4 4< t'-' 7r_ . Signature of Applicant For Signage Refer to North Andover Zoning ylaw Section 6 The proposed e is allow us in s zoning district. Issued B ate �� North Andover MIMAP May 25, 2017 i'098'.D000fi#'676 098 D 0001, 098:6-0.093 098:6-0063. J Flu a - I #676 ' �Iu Abri •'uir ' .062 i098:D=0007' __...._.. �.r..:.:_: •.: _._:_..- �Sltr..:_.:: • •°r 098:6 003:9: .... {,098 '1:0 0038 ....... �a1ri ::::' -:•.. all c .:... 098!6. 0047 # 700 - _.. • :::_. .......- - : ».::,_ .::::;. - ? #211098:8-0046 • s�,tr. '':�•: -:. �l,t ''••.•"• ,#600 098:8 0045 #207 ::.. • `- #214 flu �n& 098 .:8 -B-00 Ur s>« ? •• ..::: ySV w "�""•• #790 098:6-0048 #Z19 .. #230. ":_: ;i; #790 #,190 jig .: (#,744 098:8 004. #790#790 .... - #790#790 R•2. /#202; :_. #790 09'&B=0043 #18 #790 N'P 098dB4O04.2 098-D-0069 #733 ?�!i;• •:= #790 '�G., /#:186' 098c6-004.•1 #733 #733 114 / #800 N\ /#,1J81 114 = ��' -- :_. t098.B-004. ..._.: #800#800 098:6-0008 #800 i Batu #800 098Bs003 C7 6 #800 098.6-0045 98.D-0052 #75.7. #820 #820 098;B-0 '05 #757 098.6-0009 #820 #700 #785 #820 # 120 . #820A 098.6.0009 098.D-0053 �p� #789-793 #820aTO 30 #795 98:6-001 N N� #815 #799Qa a! #100#815 #799 098.D-0044 098.D-0050' 1.07:C-013 098.6-0054 #860, #811 I 1 #809 #807 098.D-0042 = #865 35:0-0027 #863 #871 <.•:'a.#60 107.0-0721 #869 098.D-0018 # - #861 869 "'-' #30#30 #859 #867 25:0 00.78--• #873 _ 107.0-0074 #859#857 #873 107.0-0075 107:C-007.1 Q MVPC Bo Zoning OverlayZoning E3 Municipal Boundary B Adult Entertainment Distdc . Busine s 1 District 0 Machine Shop Village Ove O Businei s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Rail Line m Watershed Protection Dist E Busine s 3 District Meters Data Sources: The data for this map was produced by Merrimack Interstates 0 Historic Mill Area ■ Busine s 4 District NORTH Valley Planning Commission (MVPC) using data provided by the Town of Interstate 0 Medical Marijuana ■ Genera Business District Of t e r qy North Andover. Additional data provided by the Executive Office of — Major Road ® Downtown Overlay District O Planne Commercial Dev sit •rra 00 Environmental Affairs/MassGIS. The information depicted on this map is Roads 0 Historic District Cortid Development Dist 3. ( for planning purposes only. It may not be adequate for legal boundary itj Osgood Smart Growth (40 O Comdo Development Dist O 16 definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER ° Easements :: Hydrographic Features C Condo Development Dist 1 A MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Industri I 1 District � Parcels Streams 41� • THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITYIndustri 12 District x t ^ * OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT WetlandsD IIndustri IS District ndustri 13 District c _ * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ♦A O Exempt Lands Reside ce 1 District '1!-, °��T�D •fit THIS INFORMATION Reside ce 2 District SSACMUS� 0 Reside ce 3 District ` de ce 4 District 1 e = 253 ft.d }.de ce 5 District i' de e . District a a esidential District KENRICK INVESTMENT GROUP Real Estate Management May 25, 2017 Town of North Andover Town Building Inspector To whom this may concern at the Town of North Andover and the Town Building Inspector Timothy Cox CITY SEALCOATING 800 Turnpike Street Suite 300 North Andover, MA 01845 Became our tenants on April 17, 2015. Very truly yours, Julie Pomodoro Jefferson Office Park TEL (978) 689-0282 800 Turnpike St., Suite 300 FAX (978) 685-1048 North Andover, Massachusetts 01845 e-mail: kenrick@officesuites.com OfficeSuites Services From: Timothy Cox <citysealcoating@gmail.com> Sent: Thursday, May 25, 2017 11:03 AM To: OfficeSuites Services; dbelanger@northandoverma.gov Subject: Fwd: Letter from landlord request. From: Timothy Cox <citysealcoating&gmail.com> Date: May 25, 2017 at 10:12:51 AM EDT To: dbelangerka,northandoverma.gov Subject: Letter from landlord request. Hi, So I'm getting a business certificate with the town of North Andover. For admin reasons and I need something stating that we have an office in the Jefferson office park. Nothing crazy just saying we do rent an office there. Thank you. Not to put a rush on it, But the sooner the better. Much appreciated! Also the town building inspector is attached in this email as he who will be needing this certificate Thanks and talk soon, Timothy Cox CITY SEALCOATING 1-800-383-8309 Citysealcoating com Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Map -/ Lot D 00 Phone:J�7,J Email A10VI" Qq ll%, fi o „ C, 7 Do you own this property? Yes No ✓ If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No Descr�et�^r f �'�Dm Fc�6e 's c�tivity(M�}stbeCNp, to f�� �(.11f7�-.� ,Q���l y s Signature of For Signage Refer to Forth Andover Zoning Bylaw Section 6 The proposed usejanlowu e ' his zoning district. Issued By Date '201--7- p Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Map -/ Lot D 00 Phone:J�7,J Email A10VI" Qq ll%, fi o „ C, 7 Do you own this property? Yes No ✓ If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No Descr�et�^r f �'�Dm Fc�6e 's c�tivity(M�}stbeCNp, to f�� �(.11f7�-.� ,Q���l y s Signature of For Signage Refer to Forth Andover Zoning Bylaw Section 6 The proposed usejanlowu e ' his zoning district. Issued By Date '201--7- Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Map 9 Lot Q a Phone:' J ' , �q�'J Email /0/" q%I i, Mj) j@ `y�w - cie Do you own this property? Yes No 1/ If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No Desc - ti rN of BURQ ss Activity (Mi}st be Compl�etAJ �� y s Signature of For Signage Refer to North Andover Zoning Bylaw Section 6 The proposed use is an allow u e i s zoning district. Issued By Date D t / S01--7— Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Addres's of Business:STr . c 6 Zoning District: Map Lot Phone: � � � i 25 � �� C Email P Ce (::(S� i y c'�%Ua �v^n Nature of Busine,, Do you own this property? Yes No "'- If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No 'Y" Description of Business Activity (Must be Completed) Q(CL V<.Q_ i liJo6J'- Signature of Applicant For Signage Refer to North Andover Zoning Bylaw Section 6 The propose . e is se in this zoning district. Issued By Date�Z 8/5/2016 NORT DOVER Massachus p Town of North Andover Mail - Fw: You may now begin to use your Davinci Virtual address Donald Belanger <dbelanger@northandoverma.gov> Fw: You may now begin to use your Davinci Virtual address 1 message Adam Porter <precisioninthecut@yahoo.com> To: dbelanger@northandoverma.gov Sent from Yahoo Mail for iPhone Begin forwarded message: Fri, Aug 5, 2016 at 8:42 AM On Thursday, August 4, 2016,11:57 AM, Mindi Helm <mhelm@davincivirtual.com> wrote: Dear Adam Porter, Great news! I am pleased to announce that you may now begin to use your virtual office address. We appreciate you taking the time to complete the required forms. Please list your address in the following format: Precision in the Cut 800 Turnpike St., Suite 300 North Andover, MA 01845 If you have any additional questions, please feel free to contact me. I am more than happy to assist you in any way possible. Don't forget you now have access to Davinci's exclusive online Meeting Room platform. This allows you to easily search, compare and book meeting rooms or day offices at any of the 850 Davinci locations worldwide. Please visit www.davincimeetingrooms.com to book your next meeting. If you have any questions, you can contact us at 877-424-9767, or send an email to info@davincimeetingrooms.com. Sincerely, Mindi Helm Davinci Virtual Customer Service Specialist Phone: 877- MY DAVINCI (877-693-2846) Fax: 888-616-1444 www.davincivirtual.com https:Hm ai l.googl e.com /m ai I/?ui=2&i k=3e210fea79&view= pt&search=i nbox&th=1565abccf264a6a2&s i m I=1565abccf264a6a2 1/2 NORTH ANDOVER. BUILDING DEPARTMENT 1600 Osgood Street North Andover . Tel: 97-8-688-99545 Fax: 979-688-9542 AUS ',�5FORMFOR TO WN CLEW D.A.TE: NAlVlEa?�Wk fou ADDRESS: Gere . • //Ojzy;� e3 0 0.1, Z®NMGMSTPNC : TYPE OF 13USINES S.' _JVI cp BUILDINGLAYOUT PROVIDED., YES ' NO ZONJNGBYLAWUS.A.CxE: NO NPEMOR SIGNA.TME ETISM SS FORM FOR TOWN CLERK 2.49 Honre f3ccupaiion (1939132) . An accessory use conducted within a dwelling by a resided who. resides in the dwelling as his principal address, which is clearly secondary 'To the use- of the building for luring ptuposes, .=Some occupations shall -:i clircle, "b6.t tot'limited to the following uses; personal services such as famished by an artist or instructor, but not occupation involved with motor vehicle repairs, beatify parlors, animal kemels, or the conduct of retail business, or the n ufachning of'goods, which impacts go residential nature of the neighborhood; 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply; a. Not more than a total of Three (3) people may be. employgq.,in tl; ,Home occupation, one of whom shall be. the-owaier ofihd home occupation and residing i a said dwelling; b. The use is carried. on strictly vAin.the principal building; c. `.'here shall. be no ex-Eador alterations, accessory buildings, or display which are not customW with residential buildings; - d. Not more than iwmn r five (25) percent of the existing gross floor area of the dtvellirag unit. so used, not to oxceed one thousand (1000) square feet; is devoted to 'such use. fn connection with such use, there is to be, kept no stock in trade, commodities or products which occupy spaw bevondthese limits; e. There wilt be no display ofgo6& or wares visible from the street; f The burldmg or premises occupied shall not be rendered ohdecironabSe or dett7mental to the residential character of the neighborhood due to the cdkdor appearance, emission of odor, gas, smoke, dust, noise,'disturbance, or in any other way become objectionable or detdmental to any residential use within the. neighborhood; g. Ai�-v such building shall include no features of design not cust6maq in buildings for residential use. In signature Dale 0 � i��� I I �x �-- Date ........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ .. '� d �'( �--- ............. has permission to perform ... 0� ....... wiring in the building of .... ...... ox ................................................... at o 6, 3 n ... 6 .... /p ..... North Andover, Mass. Fee... ...... Lic.No. n.mX . .................................................................................... -7ELECTRICAL INSPECTOR Check it . Commonwealth of Massachusetts Official Use Only '' Department of Fire Services Permit No. ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] w„ (leave blank J 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 W INK OR TYPE ALL INFORMATION) Date: O?) - (Qi " &[4 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) U `. "felLIVIVilE Owner or Tenant i/L Telephone No. Owner's Address Is this permit in conjunction with a building4)armit? Yes ❑ No (Check Appropriate Box) Purpose of Building GO~ G Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ay! r /k -L 6 -- Zo f t/ 9,C t i F /04 Fx'-->t 7W-40 W1,1,( Comnletion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans v No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above ❑ In- Swimming Pool ❑ rnd. grnd. o. of 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 Ran s g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p 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 KW Security : or Equivalent o ys vim No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, oras required by the Inspector of Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) ' Work to Start: 0%— tO ections 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 cove ge 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:. & e44 ��V > l /tom LIC. N0.:—J Licensee: iV,�y 64 _ Signature LIC. NO.: 6416 (If applicable, en er "ex e t " ' the license vumber line)Bus. Tel. No.: �.!Ih _19f'D Address: F, 114t@pee,' vx- 10/1- &" 4 Alt. Tel. No.: J-1 *Per M.G.L c. 147,'s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PE$MIT FEE. $ Signature — Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the k, notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon wrii%n application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass N Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL MSP TION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: \DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com 9\ �rt The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia f�• Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: CL( tthit� City/State/Zip: 144 ftL (_1 104 /V ����f q Phone Are you an employer? Check the appropriate box: Type of project (required): 1.0am a employer with employees (full and/or part-time).* 7. ❑ New construction 2.❑ I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity. [No workers' comp. insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work myself. [No workers' comp.. insurance required.] t 10 Building addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13.0 Roof repairs These sub -contractors have employees and have workers' comp. insurance.* 14.Other 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 0 152, § 1(4), and we have no. employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit This affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not, those entities have employees. If the sub -coli actors have employees, they must provide their workers' comp. policy number. Iain an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: ll! L-277 — Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: (�00 ToNVIli k City/State/Zip : Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under tli ai d penalties of perjury that the information provided above is true and correct / a:,�--4-.. late- 0 �^ t/ ' V146- `6 I- heti - / ,JCO Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone -d Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theiremployees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia k.. NORTH ANDOVER RUYL-DING DEPARTMENT 1.600 Osgood Street North Andover . Tel: 97.9.698-9545 Fax: 978-688-9542 USWESSFOWFOR TOWN CLERK DATE: , 6l NAM .ADDRESS; � b T(4 rio Z0N).NG,Dl9TRfC : TYPE OF13USINEsR,, Z.G(,t C CsZ BMDING LAYODT PROVIDED., YES .A. AFLARIMP iG SPAMS: Y(I sl ZONINGBY L.A.W USAGE: YES NO 4��--- JNSPJ�tTOR SIGNATURE BUSINESS FORM FOR TOWN CLERK 2.40 Rome Oceupa6on (1939132 An accessory use conducted within a dwelling b J a r idem h resides � .g �. es. .. who r srdes in the dwelling as his . address, which is clearly &econdky Io the use o£ the building for lildn pluposes, Home occupations shall '!chide, "but :cot *limited to the following uses; personal services such as fixnished by an artist or iustmdor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennds, or the conduct of retail business, or themanufaciuring o£goods, whi& impacts the residential nature ofthd neighborhood, 4.' For use of a dwelling in any residential district or Mulfii-fa r&3, district for a borne occupdizon, tho following conditions shall apply. a. Not more -Haan, a total of three (3) people may be. employed .?n th&, dome occupation, one of whom shall bet a,-owiierofttieho�ueoc pationandresidingtitsaiddwalting; b. The use is carried on Wotly -witbinthe principal building; c, There shalt be no ex-forlor alterations, accessory buildings, or display -which are not customary • with residdntial buildings; - d. Not more. than fwent ,-five, (25) percent of the exis g gross floor area of the dwaag unit. so used, not to exceed one thousand (1000) square feet; is devoted to 'such use. Six connectionwith such use, there is to be kept no stock in trade, commodities or products which occupy space beyondthese limits; d. There will be, no display ofgo6ds or wares visible from the street; f The building or premises occupied shall not Tae rendered objectionable or detrimental to the residential character of the neighborhood dud to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbatim, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design- not cusfi maV k bindings for residential Date North Andover MIMAP February 1, 2016 -q f098 D003:8 #719048 k; `19 -• #790 #210. 09.8.8-0049 D 0046, 1 �3JCi 4 #790 S# #:9. 06004740 19 #790#790 / • `�' #790 #790 D.Q04 #202 098:6-0050 098.6-004.3. #187 f?098 #790 #790 /#194: 098.D-0069 ... ... #790 098 B-0042: #177 #733 A& .::_:::::;7 #790 ==- t, , /#:1'86 �`r�f 098:B=00.4.1 #733, 7 , #733 ` I _ s #800 _... -• SSC^, 098. B-0040 #800 0986=;00;65a #170. #800 � 114 =098.D-0008 #8000 GB 098.D-0045 :: . •,i,• #820 98.D-0052 #820 #757 098.D-0009 =: #785 #820 #700098 B-0095 #820 i y #120098.D-0053 #820A 098.8-0009 # 789-793 #820a I#710 #20 #795 ¢ #795 098.6-00.0 098.D-0044#799 ' #100 #815 \�� #815 / #799 .Q�i111R�ad 098.D-0050 #25' 098.D-0054 #811 � #860 #809 O `• 107.0-0111 / / #807 098. D-0042 #865#871 1 #863 #60 107.C-0072#869 114 #869 #866{ 098.D-0018 #30#30 #8591 #867 " ? #859 #873 -- _:.?��:• 107.0-0074 07X- 004 #857 #873 \ \ #855 \\ j v #35 _..• :::_. .... #33 25:0=_O'0178`�' •"• ' 107.0-0075 ! 307.0-0076 d '` 107.0-0071 -::' �alfi .::_ -..• ::..:: #65 #30 #815 .1�07.0-0113 #85 t :c:. :-- ••.....:. •� �" �' t 107.0-0022 #8.15 _:...` •. 107.0=0083'' • #85 r' 107.0-0023 -:...:' #85 e- a MVPC Bo Zoning Overlay Zoning Ej Municipal Boundary 13 Adult Entertainment Distric C) Machine Shop Village Ove ,' Busine 0 Busine s 1 District s 2 District Honwntal Datum: MA Slateplane Coordinate System, Datum NAD83, - Rail Line Interstales - 1 - SR M Watershed Protection Dist 0 Historic Mill Area 0 Medical Marijuana ® Downtown Overlay District 0 Historic District 0 Busine 0 Busine m Genera 0 Planne 0 Corrido s 3 District s 4 District 14ORTFI Business District Of •• N� Commercial Dev = •�*� r•�• O Development Dist • OL Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is - Roads Ill Easements ❑ V Osgood Smart Growth (40 0 Hydrographic Features 0 Corrido 0 Corrido Industri 3 Development Disl O -- A Development Dist 1 District t ; for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY Parcels - Streams 0 Industri 0 2 District S w OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Wetlands Ind ustri 3 District e d ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Exempt Lands O Industri Reside _ - S District •� ce 1 Dislnct �lo•4ro ♦�t.(�7 THIS INFORMATION :: Reside ce 2 District 'rSACNUs� 0 Raeide ce 3 District dedalois de ce fi District ,,,age Residential District ''{[��'-'''g�y(' ',����(D��f'.'%jE D (/�'�(.. NORT 1600 Osgood Street '�`. s ?dfiio F Kg5 � . . sAcNus�. , North A duver _ Tel: .97.8-X 88.045 F 979-µ68S-9542 .131, MSSEO"FOR TOWNC�� DATE, 1. zzo-c�/�� f PlI Co AAAe,9e1t ei► t-J l,1L1, /? I'r'J�j � TYPE OFWSMS t NO ZOWMGB-fY AWTJgAGF,: No INSPECTOR. SIGNATINX, x.40 Rome Occupallon (1939132) An accessoty use conducted a a dwelling by a x-esideptwho a:es des !a the dpveliing as his Principal address, wh 9h is dearly secondary 10 the use. of theb.0ding. for living pirposes. Home cccapaiions shall `iiicl�do,."but Aot ted to the tolloA tzg uses; personal services such as ffirnislied by au adW or instmotor, but not occupaaaa iiavolved w6 zotor+vehicle xepairs, beauty padors, animal iwauls, or tb© condaxct of retail bt?siuess, ox thoxmi faoitatYtig of goods, wbici impacts t& residential nature ofthe neighborhood; 4, For use of a dweiliitg, in any iresidential. district or multi-fhmi y district for a home occup660n, 60 foltowizig oondiiions shat apply. a. Not more than a totat of three (3) people may be employed in the, home occupation, ono of whomshalt be the, ow ier o£thd home occupation and xodding iil said dzrleiling; b. The use is canicA on strictly witbin.ihe principal building, c. `Where st all be no ox-todor altorafow, accessory buildings, or dliplay which aro not cuIbnIW with reside fid buildings; . a. Not more. than iwent f Te x(25) percont of the eking gross :floor area of trio dwelling unit . so usA wlt to excW one thousand (1000) squaro feet, is devoted to'such •uso. fn. conaec�.oxa.'wa'fh • fmoh .uaa, fhera is to be kept no stock in trade, comTnodifiw or prodaofs which occupy space be�'ortd titese.limits; Q.. UP= displayofgodds or wares visible frm rho &wt; f; Tic bd ft or promises occupied s got bo xendezed objectionable or dettimmtel to the, xesidentid character of the neighborhood: duo to tho eztwiox app=anco, emissiozi of odor; gas, szazoke, dust, noise; tlisirzrbance, of in any c&er way bzcome objectionable or de mW to anyxesidential use wit%; the nai borbood; g. Any sach building shalt include no features ofE desi - not cust6max-y in buildings for res-I'Ac iiai tse. j North Andover MIMAP January 7, 2016 CD2' •- ..�:•:-::_ :a! • :... 098'6 00':4__3 09.8.67004.1 Ju #800 .:_ _. •:'. #800 #800 - #800 "' Ai #800 `� )980'. 980 OObS _ #800#800 Cos\ #800 #800 .:•�_. •-_.. _ 098.D-0008 i #820 #757 098.D-0009 `"' #$20 #820 098:6=0095. #785 #820#820 #;700 �\ #820A #820a#710' #789-793 098•.6=0009 82 #795 ; #795#795 + 098. B-001 098.D-004.4 #799 Id1 #8.15 #799 #815 #799 098.D-0050 �� 307.0-01'31 S� ' #811 I1 �' #811 098:D-0.0�5•.�4 #809 \ 098D-0042 #807 Willow<Street� #865 098.D-0018 168' 'n #863 #871 #60. a #869' 107.0-0072 #869 S #.86.1 #30 -O #867 car #30O. p #859 #873 107.0-0074 �.% #859#859 #873 #873#867 #857 #855 #35 m m 107.0-0076 107,C-0075 #37 ~ 107.0-0071 #33: q� #31 D % MVPC Bo Wetlands Zoning Y; Busine [,`�' Municipal Boundary C Exempt Lands R Busine s 1 District s 2 District Hon—tal Datum: MA Slaleplane Coordinate System, Datum NAD83, - Rail Line M Busine Interstates ® Busine s 3 District s 4 District - gCRTH Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of — 1 0 Genera — SR t0 Planne 13 Comido Business Districtr Ct oto �i� Commercial Dev ? .41 6.1 DO Development Dist North Andover. Additional data provided by the Executive Office of Environmental AHaim/MassGIS. The information depicted on this map is -- Roads R Corrido 6 Easements i0 Corrido 3' L Development Dist p zi ' R Development Dist 1' for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Indu.tri El Parcels fl Industn I 1 District i 1{ it2 District i w # THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Zoning Overlay 0 Induslri 0 Adult Entertainment fl3 Distract x �o .r y • ••�^�- ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF O Induslri Downtown Overlay District Resideice S District 1 District 7, +O*A go . ono � THIS INFORMATION © Historic District r Reside 0 Water Protection W Reside ce 2 District $SA�INUS�t ce 3 Disidct C Hydrographic Features A de ce 4 District -� Streams 1" = 180 ft •q Ytde ce5 Disidct YYY de ce 6 District m e esidenlial District AMERICAN CLAIMS SERVICE MULTI -LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 INSURED: Grace Point Community Church ADDRESS: 800 Turnpike Street Suite 300 North Andover POLICY: CPP160594523 LOSS DATE: 02/16/2015 LOSS TYPE; Pipe Burst ACS FILE: 31167 PD Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Tim McLaughlin Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 02/18/2015 7 KIMBALL LANE, BUILDING C, LYNNFIELD, MASSACHUSETTS 01940 TELEPHONE (781) 245-9516 / FAX (781) 245-1077 E-MAIL — daims.aes@verizon.net NORTH ANDOVER BUILDING DEPARTAI EIS T 1600 Osgood Street North Andover Tel: 978-688-4545 . Fax: 978688-9542 .USN 'SS FORM., OR TOWN CLERK Al NAGE: iy c. �\v ADDRESS:- i� 1 lllcq\�,0�4 oNMGDrSTR-FC T : - -- TYPE OF)BUSINESS: BUMDII G LAYOUT' JPR OVIDED:_ YES NO AVAILABLE PAR KMG SP.A.MS: ZONING BY LAW USAGE: YES NO MWT'OR. SIGNAT STM EUSMSSFORMFOP MWNCLERK 2AO Hoene Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the we. of the -building for luring purposes. Home occupations shall `include, "but not *limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with. motor vehicle repairs, beauty parlors, animal kennels, or the conduct o£ retail business, or the manufag of goods, which impacts utile residential nature of the neighborhood, d. For use of a dwelling in any residential. district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the. hbme occupation and residing in said dwelling; b. The use is carried on strictly withiathe principal building, c. There shall be no ex -tenor alterations, accessory buildings, or display which are not customaW with residential buildings; . d. Not more than ivvmt , five (25) percent of the existing gross floor area of ;the di velling unit • so used, not to exceed one thousand (1000) square feety is devoted. to 'such use. In connection with such use, there is to be. kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exte&r appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of desigtt not customai:y in buildings for residential use. Signature Date u A ��� Ik This certifies that .... 6wl e- 2-o k AL has penmssion to pertonn ................ U�2 ...................... wiring in -the building of ... p%t R S LO— ...................................... 0 .......... ................................ at ........................ ........'� �...I...E....� ............... . N, orth AndoverMass.c........................A....................�..� Vee... 0..... Lic. No.1319.. .....M..P Check 4 (0-1 Date .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 12125 uv�._ 1115)14 I Commonwealth of Massachusetts Official Use Only rs Department of Fire Services Permit No. �i o BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL )NFORMATION) Date: 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 8 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building (-,W—b� Deep VO4nP No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fwd �c-u��•-(-j�� r Completion of the following table maybe 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 Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o 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 No. of Waste Disposers HeatPump Totals: Number """""""""."""."' Tons 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 ICS Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) _ Work to Start: �Jo Q 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 El BOND ❑ OTHER ❑ (Specify:) I certify, under the gins and penalties ofperjury, that the information on this application is true and complete. FIRM NAME:. LIC. NO.: A t 4-) 3 Licensee: _q�pprt1t Signature LTC. NO.:1p- (If applicable, enter `exe pt" in the ltmwA number line) Bus. Tel. No.: q -LWI -96;Q Address: 2- Pow Vli,,-y Raco Tutacslorry MSA 018`7k Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work require 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 FP8&ffTFEE.- $ V!5Signature Telephone No. 7 e--e-�4- ✓n- -)- IO I ILJ INJ tet'" ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed r on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: k Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Y Failed Re- Inspection Required ($.) ❑ Inspectors om . ents: 6 41 Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com a• 1 The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Address: 2 Po,rA &,w Boa-_;, City/State/Zip: foo Phone #: q_9 -64R-2- 91 Type of project (required): 6. 0 New construction 7. 0 Remodeling 8. 0 Demolition 9. 0 Building addition 10.R Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a r fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert& under the pains and penalties ofperjury that the information provided above is true and correct. - Signature: 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Are you an employer? Check the appropriate box: 1. ; I am a employer with l O 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. t 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' s comp. insurance required.] Type of project (required): 6. 0 New construction 7. 0 Remodeling 8. 0 Demolition 9. 0 Building addition 10.R Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:, Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a r fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert& under the pains and penalties ofperjury that the information provided above is true and correct. - Signature: 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. 1f an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. C The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Mossachusetts Department ofIndusWal Accidents pfflce of Iuvestigatious 600 'Washington Street Boston} MA. 02111 Tel. # 617-727-4900 ext 406 or 1-877:MA.SSAk'B Revised 5-26-05 Fax # 617-727;7749 _WWW-Mass,govfdza I ssu A S... R. M., E FOLLOWINV"'LICE URN EYK-A,'.,N:::,,.,E L E C,,T,-r;,i- Date... ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING MCJ /1 !� o -A, (I& This certifies that ..Je_ C <� 4A r -i ............ .... 4 ................................................................................................ has permission to perform ............Z. -e- A I A -e- -4 ...... to ......................................... ....... P"4 tp-G wiring in the building of.......... . ..................................................................................... 'r &io - �A �P- t-� t \ L�'— at ..................... .............................. ............................................ ................................North Andover, ss. llul'll Fee ,Q-. ...... Lic. No.17.1.2.- . .. . ............. ........ .. ......... 2� � . Check # MEcnucAL INSPECT 11397 r Commonwealth of Massachusetts Official Use my Permit No. o Department of Fire Services Occupancy and Fee Checked aM BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 27 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date: /0/0/ / 3 City or Town of: NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ,Yya wl .o- S/,-� �,� Owner or Tenant Al S parqn er- Owner's Address Telephone No. (v/i - Is this permit in conjunction with a building permit? Yes ❑ No ®' (Check Appropriate Box) Purpose of Building Coop%^ , c= o ( Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Completion ofthe following table may be waived F t' I-nector of Wires. o. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of "otal Transformers . ''JA o. of Luminaire Outlets [No. No. of Hot Tubs Generators X0 of Luminaires Swimming Pool Above ❑ In ❑ rnd. grnd. NO. o mergency 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 KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec ical Work: 9—, o o6 (When required by municipal policy.) 6 Work to Start: /o 3 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C RAGE: 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: INSURA-NCE 0"' BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and enalties of per ry, that the information on this application is true and complete. FIRMNAME. _-� I a- - LIC. NO.: Licensee:/!% i/2 �s i� Signature LIC. NO.: a/ '�02 A (If applicable, enter "exempt" in the license number line.) Bus. Tel. No. • 14 Address:.. j'd,%drj e. -z PIA e, %��iti�S�.� /r%� a1�9 S Alt. Tel. No.:579V-6 y�-GSryy� *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Fppg�iTFEE.- $ A2� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass r5l Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ' ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION• Pass�Z_ M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: - Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street .Boston, MA 02111 UT www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Orgaaization/fndividual): C� ro g ra C_ Address: 2 10 City/State/Zip: / kms 6e_� r #• �, 9 �--6y9- 5�G9 �) Are you an employer? Check the appropriate box: - Type of project (required): 1. [ c I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have liired the sub -contractors �• [J Remodeling 2. F1 am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. F1Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[46ectrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roofrepairs insurance . re uired required.] employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. �J . y Insurance Company Name: %J S e0c) J d � Policy # or Self -ins. Lie. #: (n/ M Z 1?06 .S"S 2 3e,,1.2 o / �. ExpirationDate: Job $ite Address: ��d �U�n J4 Cit3' p /State/Zi : hl'! ✓dd d1 �° � • �S"� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of 'Investigations of the AIA for insurance coverage verification. Xdo Iaereby certify u Meoliepains andpen es ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: , Phone #: Information and Instr actions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or written." An em ployeiis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a j oint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date"the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pemiit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Goinmomoalth ofMossachvsoits Dapadment of.ladustdal .Accxdojuts Me of Iavestigatim 600 Wasbiugton Stroet Boston, MA 02111 TA, # 61.7-727-4900 ext 406 ox 1-877-MASSAF., Revised 5-26-05 Fax # 617"727;7749 vc�_mace ansrfrl;� Date....... Av TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .................................................................. .............. ......... ,��has permission to perform ........ ........ '0 4P'.r . .. ... V ........... ......... 'x ? V4 ...... ........ wiring in the building of ....................................................... ........................ .... , -1) TC11 i��. ..... A/ .......... at .... P ...................... North Andover, Mass: Fee e d 5� ...... Lic. No............7 ........... . ...... , . .............. '... --***E�CCAL INSPECTOR Check # 12081 �V4 5'to- ►`� �n^ ��i�i'�i 401 "Lalth of Massachusetts OfficiatUse0rily Department of Fire Services Permit No. �( I BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ZM 1/071 tleave.h1snkl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 0ffic), 527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention toopperform the electrical work described below. Location (Street & Number) <�,U6 -TO, R --r J �&,c / Owner or Tenant r Telephone No. Owner's AddressL% Is this permit in conjunction with a building permit? Yes Purpose of Building _6C.0i cc_ S `+ (e- Number P No ❑ (Check Appropriate Box) Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W 6 Z c - yr k Undgrd ❑ No. of Meters Undgrd ❑ 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 Cj J 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 S No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: r Numb---J " ­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 KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: U u An c., e,L�1S - v S Aiiach additional detail if desired, or asYequired 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. n FIRM NAME: �� S C,�t� r, iv (. �,z � i t� LIC. NO.: 77; !� Licensee: Signature re— T LTC. NO.: (If applicable, enter "exempt' i the icense nzim er line.) Bus. Tel. No.:!9 7�- 3755 9 fe Address: 'KA e4 4 G Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, secure k worrequires epartment of ubhc Safety "S License: Lic. No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. s I Signature Telephone No. C+ S ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of.ongoing construction activity, and may be deemed-bythe Inspector of Wires abandoned.and invalid ifhe_.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending'through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Com nts: Inspectors Signature: Date: FINAL INSPEC IO : Pass 0 I r Failed Re- Inspection Required ($.) ❑ Inspectors Comment . Inspectors Signat re: Date: U DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com a The Commonwealth of Massachusetts - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: // S A rU 1 d 1C City/State/Zip:L Phone -- �l 3� Are yo employer? Check the appropriate box: Type of project (required): 1. I am a employer with �i 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for in an capacity. g Y p tY• workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 1011 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] i employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. (Z -PV C (Pa S -T, i� S 01Z Af- ( "" Insurance Company N Policy # or Self -ins. Lie. #: Expiration Date: L` ._ L q r N Job Site Address: U2N (%1 Z S 1 City/State/Zip:AZZ_�k. i 1, 4f„ (),M Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a itne 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 certo under thepains and penalties of perjury that the information provided above is true and correct. Signature: �_��-(-r� / 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Information and Instructions Massachusetts General Taws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, • express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial 4 Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of '{ Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' , compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials PIease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. ' I The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The CoOxtweaxthofMassachusetts Department of I ndustdal Accidents Office ofInvestfgatlons 600 Washinpa Street Boston} MA. 02111 Tei, # 617-7274904 ext 406 ox 1-877, ASS.A.BE Revised 5-26-05 Fax # 617-727-7749 www.ntass.govaa Iq6 Q¢.. N r L:� Z tx CL o LL fl v Z cy W pp o = O c.Q WG 1Z Date../ ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that tl%�a .............. 7../ ................. .............................. z ....................................... Ve has permission to perform ........ . .................................... . ................................. wmiiing in the building of ............................................................... at ... orth Andover, Mass. 000""V Feb /0? ': ......... ........ Lic. No . . .... .... . .......... CAL IN EL R ack #IQ 75 2 0 0 4' Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7 o 12, Occupancy and Fee Checked [Rev. 1/071 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: j r O' / 3 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) 'got) ?tl i°{^/ �� )��-hr��-� �� 1 2 8 6 Owner or Tenant . Telephone No. R 1 g - (o$',z-j,400 Owner's Address 790 -ro Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C a m mt m k 0 f+ I UL 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: V01 C I 4-,7-A4 Cyte tnt 5 Z ot.J (/AL 4^ 9 ComDletion of the following lahle may he waived by the Invnertnr of Wire.c No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑o. nd. grnd. 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 eat Pump Totals: Number TonsKW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent uivalentNo. No. Hydromassage Bathtubs No. of Motors Total HP - Telecommunications Wiring: No. of Devices or Equivalent OTHER: Estimated Value of Electrical Work: 31 F60 Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: 111o113 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: C d R Po r� fe Te I e�h. �rz: SeLsf« s -t 4 c LTC. NO.: Licensee: Signature,,- LIC. NO.: (Ifapplicable, enter "exempt,, in the license nfiumbe lanSe.) ^r Bus. Tel. No.: 6 17 -4, ZS` / 2 D l Yx&igAddress: 2�� /'T/ 2/ 2 % d Alt. Tel. No.: 711 •- yl 3 -- // a f *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 4 q J I - /V-/ (� 1�t-1 V, �j The Commonwealth of Massachusettsm Pririt Form Department of Industrial Accidents Office of Investigations IV 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Corporate Telephone Services, Inc. Address: 184 West 2nd Street Phone #:617-625-1200 Are you an employer? Check the appropriate box: 1. I am a employer with 8 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. 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. ❑ 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 per MGL insurance required.] t c. 152, §1(4), and we have no / employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 - Plumbing repairs or additions 12.0 Roof repairs 13.❑✓ Otherl-ow Voltage ;Any applicant that checks box #1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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 my employees. Below is the policy and job site information. Insurance Company Name: Traveler's insurance Policy # or Self -ins. Lic. #:8857L928 Expiration Date: 12/31/2014 Job Site Address:800 Turnpike Street City/State/Zip:North Andover 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 oPup 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. under h ains and enalties o er'u that the in ormation provided above is true and correct ( r. .978-745-3300 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• I it A 'i U71 Date ..... / 0—le- ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING .D -I-- "e _5 JC Thiscertifies that ............ .............................................................. ........... has permission to perform ...... 5014:5�'-67e .. ........ ............................... / .. .. ....... wiringin the building of ............. ........................................................... at...................................... . /Morth Andover, Mass. Fee../...T c. No. ....... .............. Li c. INSPE, Check # 4 41 -,Commonwealth of Massachusetts Official Use Only ti Department of Fire Services Permit No. to 571 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] geaveblank 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 OR TYPE ALL INFORMATION) Date: 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) '�- 05�'y ryT e R r 5 ire Z U 3 Owner or Tenant S Telephone No. Owner's Address / Z 1 ti rvv __ _(.J � V �R>✓ MA Is this permit in conjunction with a building permit? Yes Q --'No ❑ (Check Appropriate Box) Purpose of Buildingy FF A Cc S P)4 cc- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and.Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: (Z C'-NUUA�l� ' 1-�J RQ, �1y� U i �' C� n n Completion of the following table may be waived by the In ector 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 w t rl j Swimming Pool Above ❑In- ❑ nd. o. o Emergency Lighting Battery atte Units No. of Receptacle Outlets 2S No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. (� of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. i/ Total Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Dis posers p Totals: `.................... Detection/Merting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers rY Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsNo. ofevices E uivalent OTHER: S 1 u 2k i j $ 1" -s �,. c j �r�cn r"► C L, U 6 i Gl e-� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1'-�3 CSU 0 i bei (When required by municipal policy.) Work to Start: l b ,- j q-11 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 cMBONDE] in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify:) L i 0'% l ► J—Y. A, -d. CG e1 n I certify, under thepains andpenalties of perj�, that the information on this application is true and complete. FIRM NAME:1'�> S, C h ArtN C LeX l .� N L LIC. NO.: Licensee: t7,)jj n,, t ed_ L4 SC1✓� CPN Signature LIC. NO.: r 3 v �-� A (Ifapplicable, enter "exempt" in the Ii erase number line.) lJ Ll Bus. Tel. No.• �7 -37 S'3 j<3) Address: S �1 ��C rut �3 l P Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 01C [0-4-11 �� The Commonwealth of Massachusetts Department of Industrial Accidents i • Office of Investigations 11 ' ° 600 Washington Street Boston, MA 02111 www.nuwss gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Atsnlicant Information Please Print Legibly Name (Business/organization/Individual): Address: City/State/Zip: Are u an employer? Check.the appropriate box: 1.I am a employer with 2- 4, ❑ 1 2.❑ 3.❑ employees (full and/or part-time),* I am.a.sole proprietor or partner- ship and. have no employees working .for mein' any capacity. [No workers' comp. insurance required.] I airs a homeowner doing all work myself. [No -workers' comp. insurance required.] t - 4 Phone #: . am a general contractor and I have hired the sub -contractors listed on the attached sheet t These subcontractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL .c. 1.52, § 1(4),' and we have no .employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Q Remodeling S. ❑ Demolition 9. ❑ B ' ding addition 10, E916ectrical repairs or additions 11.[] Plumbing repairs or additions 12.[] Roof repairs 13.❑.Other • -•v ..14L wl"KS oox If i must also hu out the section below showing their workers' bompensation policy information. t Homeowners who submit this affidavit indicating they are daring all work and then hire outside con tConttractors must submit a new affidavit indicating such. raetors that check this box must an additional sheet showing the name of the sub -contractors and their workers' camp, policy infarmation. I ant an employer that isprovidingr:workers $ compensation insurance for nary employees: Below is the information. policy and job site Insurance Company Name: Policy 4 or Self -ins. Lie. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A 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 WORT{ ORDER and a fine of up to $250.00 a day against -the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u airs and penalties f perjury that the information provided above is true and correct -Z7S-3 F3 Official use only. Do not write in this area, to be completed by city or town. officiaC City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person Phone #: .i 1-% I r 0373 Date......` TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that.................................b.../.............................................. has permission to perform ....�'.�7-`t........-'�" ............... wiring in the building of ........l C�..�.�.........C:�.�....... S� Zd,3 at ... m,�%•l.l..�At�z..�� ...5i ....................... , North Andover, Mass. Fee .. ............ Lic. No......... .......... ELECTRICALINSPECTO Check # •1 I — _ LommottcveaR ol (J�%rjaachetjel7` Official Use Only -_ :..... l�. ermit Iv'o. _ / 2epartrnent o/sire �ervicej P - BOARD OF FIRE PREVENTION REGULATIONS I Occupancy and Fee Checked [Rev. 1/U"1] (leave blank) APPLICATION FOR PERM, 1T 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 INFORIu1AT10N) Tate: City or Town of: Upr-4-) A k),Ao\er 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 & tuber) R'0 a u fyt n t kp �UA& aft Owner'or Tenant T, 0 02 Q 1EA C- -7—e S+ y� C��- Telephone No. Owner's Address Is this permit in conjunction with a bullding.permit? 'Yes ❑ • 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: l�er�ct C& �, "CrLAX v`L r ��z its -rim r-r.L_ r_:: No. of Recessed Luminaires « . w—rvinv No. of Ceil.-Susp. (Paddle) Fans -ure may oe watvea OV tne Inspector o/ Wires. No. of total Transformers K17A No. of Luminaire Outlets No. of Plot Tubs _ Generators KVA T No, of Luminaires Swimming PoolAbove ❑ Fn- ❑ o,. Wr h,rrrergency Lighting rnd. grnd. Batte Units No. of Receptacle Outlets No, of •Oil Burneis FIRE ALARMS No. of Zones No. of'Switches No. of Gas Burners No. of Defection aiTF---- ' Initiating Devices No. of Ranges No. of Air Cond. 'onsl _ No, of Alerting Devices No. of Waste Disposers Pleat Pump 1)?umbe�. Tons KEN Totals: ........- iYo, ofSelf-Contained Detection/Alerting No. of Dishwashers Space/Area heating KWLocr Devices unlci5al onnec ❑ Other No. of Dryers Heating Appliancesecuri Kyy ty S stems: * No. of Watere Heaters KW No. of No. of uivalent Data Wiring: ' Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: -- No. of Devices or Equivalent OTHER: 1pg- 1-163'7 Attach additional detail if desired, or as required by the Inspector of Wires. l Estimated Value of lectrical Mork: _ 075, (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 [�j BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties of perjury, -that thein ormation. on this application is true and complete. FIRM NAME: -DT --sc -t� -� LIC. NO.: L V51 Licensee: Si�natu — b LTC. NO.: G J (Ifapplicavle, enter "exem t" in the license n e. Tel. (oar y�tb'�%nZc� Address: _ L? C,t� n d� 6 `. 1� `t�� �j U av Bus. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety � License: Alt. T cf No. Oo `f s 3 <<�>, OWNER'S lNSURANC:E WAIVER:, 1 am aware that the Licensee does not have the liability insurance coverage nonbally required by lave . By'my signature below, I hereby waive this requirement. I am the (check one) [I owner C] ownef's agent. Owner/Agent Signature _ Telephone No. FPERMTHT FEE: 5 -REGISTERED SYSTEM C ,. . 15SUESTHEABOVELICENSETCJ: _ �D.T;"SE CURI I -Y, S_ERVICES,:.INC: - - ..1 APK :A :BR0PIIY': SR - f� :i'UNXVERS•ITY--AVE -.FEES T,W.ClOD MA':.02.090-�31.J.:' _ ~r: C 07/31/13 "',� 't v:�'1 �•«, J*<� t:ll• til i �' -ICA" Fold. .. "Fob. Than Deutz Alang.All P5raradom 0_X Keep top for receipt and change of addre DPS-GAt C SIJ-10."J9-7o562ooeUCEnSEFOR>"7 ✓�c '�n»ancnnu cal,/x u ✓12auu�l�� eGGi `2x DEPARTMENT OF PUBLIC SAFETY HMO S - License H? - -Number:' SS CO 000953 "�-_• Expires:02/07/2013 - Tr. no: 195.0 S -License: ADT . MARKA BROPHY•SR' 410 UNIVERSITY AVE., - 1 WESTINOOD, IJA 02090 �-- DIG SAFE'CALL CENTER: '(BBB) 344-7233. Commissioner Date..l..7./ .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............... k-7-5 ......... . ................................ ................. ............ ...... has permission to perform ............. I ............ ............. ................................... wiring in the building of ................................................................................... ..F(:56 LJIkk Plk4-- Sr- 3 ... North Andover, Mass. ........................ . ......................................... 111A Fee .[.;?477��Tic. No........... .................. .. .. . .......... Check 'I 38� z /L�EiCTRI AL INSPEc�roR v Commonwealth of Massachusetts Official Use Only Permit No. t J Department of Fire Services up, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (� l Z l City or Town of NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfo the electrical work described below. Location (Street & NyAber) Owner or Tenant � � r ��5 1 0 n Telephone No.a 17 /- 9zz� Owner's Address . Is this permit in conjunction with a building permit? Yes ❑ No gJ (Check Appropriate Box) Purpose of Building com ry1,,,i4 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:I �,�A A� I t I w1G i Y-) 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 Swimming Pool Above ❑In- EJo. rnd. rnd. 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 " 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 Signs Ballasts Data Wiring: 30 No. of Devices r Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: q No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elecrical Work: (When required by municipal policy.) Work to Start: 16 1131 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C E GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov rage 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: - KT,� /I I , A LIC. NO.: Licensee: Signature _ LIC. NO.: (If applicable, enter "exempt" in the license number 4ne ) JV — Bus. Tel. No. -7R 14-ig, M Address: 51e, � Q,6 jd1 OT 180 Alt. Tel. No.: *Per M.G.L c. 1.47, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ r� t7r IL, 4 Date.. /10P ............................... TOWN OF NORTH ANDOVER PERMITFOR WIRING This certifies that ........t ........... ......... & 1 6Vd ............ ............................. has permission to perform ............................... wiring in the building of ...... ............................. North Andover, Mass. ii"EAICAL INSPECTOR Check# 10420 ,.r N Commonwealth of Massachusetts Official Use Only Department of Fire Services Pen -nit No. 'Q Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ) D 14 1 City or Town of. NORTH ANDOVER To theIn p ce or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) G oo Turn jq r � e S Ye e I' Owner or Tenant I'rc) me t r c- s Owner's Address 1 C U Is this permit in conjunction with a build) g permit? Yes ❑ Purpose of Building fO-),nq Cerl Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposgd Electrical Work: GlyU l2C0yJI Telephone No. r�ve rL 60C No JR (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters (i CC: TV sv s i -'e tyi r o bsertl lo,, Cmmmlefinn nfthn full—i— t�hl, . , A. A.. ,i.- 1--- ..fur___ No. of Recessed Luminaires -- -- ._.__.. _ ..... ...... .. .... No. of Ceil: Susp. (Paddle) Fans . ....,... ......,n� cuvr v rrtre5. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In -of rnd. rnd. o Emergency Lighting Batter 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. Tons Tot No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .•..... Tons ' ""............ KW " .....•.... No. of Self -Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Local ❑ Munic]pal ❑ 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 Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Eq uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Wi 00 (When required by municipal policy.) Work to Start: 11 410 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C E GE: 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 �71 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, lhat the information on this application is true and complete. nn FIRM NAME: f;[ to S LwS LIC. NO.: 145 3 6A Licensee: Gere r64 1' ignature LIC. NO.: 14 j 36 A (If applicable, ent "exerWl11 in the h sen nber 1' ) Address: r .l a h n /4J CLQ /7 �b l Q LO 2� Bus. Tel. No.'701-364-113S- J,( Alt. Tel. No.: 7 1 ' 5 7- -- i k oc *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SDO /31.3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ / Z S. D 1 9653 Date ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 5e hARV ��e7-12-1 e'— Thiscertifies that ............................................................ . .............................. has permission to perform ............ A-1 7- .. ............................................................... wiring in the building of ......... ............................... at ......... 7 .1...PC... ANorth Andover, Mass. .. ...................... ,;p7# .............. Fee..(.�57 Lic. No. %� 0. .................... .. ........... EL ECTRICAL INSPECTOR Check # --3 s57- Department of Fire Services Permit No. % � 3 p Occupancy and Fee Checked d BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6)_ 2") d 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) Offo— lis2/� Pt �,L X11) _SL TrG 10 11 Owner or Tenant Owner's Address u -5. irG 10 Is this permit in conjunction with a building permit? Yes L Purpose of Building C tn) RU(-'�'�c 11 'n p r 1 � c Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service 1e,0 Amps 1-20 -tyf Volts Overhead ❑ Overhead ❑ New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Undgrd ©__ No. of Meters Undgrd ❑ No. of Meters ' _ Q Pel a6&lvk . e_YI C I !'.mmnletion of the following table may be waived by the Inspector of Wires. Attach additional detail if -desired, or as required by the inspector oj wares. Estimated Value of Electrical Work: j(+ t- (When required by municipal policy.) Work to Start: '9r ­� r l v 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 Coveras in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND F]OTHER ❑ (Specify:) L -/6d 1JrL —7—t l) I certify, tinder the pains and penalties of perjury, that the information on this applic tion is true and complete. FIRM NAME:,Lh ��`� 1 G��(� 1 _ LIC. NO.: 130 1 Licensee: - 6 0" 4c 1... Signature _ LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: H 7 V- Address: 1141:5,4 2 "(/ 41 �l I )P,-�. i eA /1-1"o Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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) [_1 owner E] owner's Owner/Agent PERMIT FEE: $ Signature Telephone No. a Total No. of Recessed Luminaires No. of Ceil: Sus addle Fans P �) TransTrsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑o. rnd. grnd. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Detection and No. of Switches 2 No. of Gas Burners Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Dis osers p Totals: ction/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal E] Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: (tiS�AI� AM� ('(Slutit`ta Attach additional detail if -desired, or as required by the inspector oj wares. Estimated Value of Electrical Work: j(+ t- (When required by municipal policy.) Work to Start: '9r ­� r l v 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 Coveras in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND F]OTHER ❑ (Specify:) L -/6d 1JrL —7—t l) I certify, tinder the pains and penalties of perjury, that the information on this applic tion is true and complete. FIRM NAME:,Lh ��`� 1 G��(� 1 _ LIC. NO.: 130 1 Licensee: - 6 0" 4c 1... Signature _ LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: H 7 V- Address: 1141:5,4 2 "(/ 41 �l I )P,-�. i eA /1-1"o Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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) [_1 owner E] owner's Owner/Agent PERMIT FEE: $ Signature Telephone No. a r� The 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 Applicant Information Please Print Legibly i Name (Business/OrganizationAndividual): Address: City/State/Zip:_ P -L l (,A Phone #: Are you an employer? Check the appropriate box: 1. jre ` I am a employer with $ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. g 8. ❑ Demolition 9. ❑ Building addition 10. ectrical repairs or additions 11. F1 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: -7 9 D I U rUv P 4 k,�q- Su I ) C ) ��� City/State/Zip: /V -11- d l/L-e1 L %117 ,A 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 certify under the pains and penalties goer iry that the information provided above is true and correct. 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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 7 Location bo /t-t-jg Ke No. Date NORTq TOWN OF NORTH ANDOVER D o ; : Certificate of Occupancy $ /O -Z),," s Must Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 17d 2 3" 17 B ilding Inspector 11 c�,.O eT •'�h ,JSACH�SES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 212-2011 Date: October 4, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 800 Turnpike Street, North Andover, MA MAY BE OCCUPIED AS a chiropractic office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Merrimack Valley Family Chiropractic Fee: $100.00 Receipt 23517 Building Inspector W W Cd Fj I I -' 0 0 CD L Z o Q. O CO) O O I cm .C#* o� y CD m m C D CL � O � 3� O G O L cc O d �Q CA C � O rY CJ J .fl .Qca O C Z CD CL V CO) c C C.— C y D 0 LLI cl U) uj W W U) c Q o a� c CIS ` C N �1oc x x v v a r C ;= O • y.r 'yr O � N : ® c :0a �EE CD ,o c� �.coa u rn I.. QCD c a . 6 CO �_m o m .O LN C c y N O G m. L a a i�� u S W z ,c cc 0 w° cinno' Z O c! C O Q )U5. Y cd C/)w ii m C/) /) I -' 0 0 CD L Z o Q. O CO) O O I cm .C#* o� y CD m m C D CL � O � 3� O G O L cc O d �Q CA C � O rY CJ J .fl .Qca O C Z CD CL V CO) c C C.— C y D 0 LLI cl U) uj W W U) c Q o a� c CIS ` C N �1oc v v Y! C c R C ;= O • y.r 'yr O � N : ® c :0a �EE CD ,o c� �.coa u rn I.. QCD c a . 6 CO �_m o m .O LN C c y N O m. L ` + N m >0 = cc Z O c! C O Q 'O N CD 0 m y O v6C2 Z C Ci •O F- m N m C = m :map N ~ 0 N m H O y0+ Z .N r.+ .. MD o •m c E m � •N Z O VU v®9 c COD a m� o� = ` H O Z � eNa � D CL C=C3 I -' 0 0 CD L Z o Q. O CO) O O I cm .C#* o� y CD m m C D CL � O � 3� O G O L cc O d �Q CA C � O rY CJ J .fl .Qca O C Z CD CL V CO) c C C.— C y D 0 LLI cl U) uj W W U) Date . .......... 0ORT" 0 4 TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING VA. r W-- This certifies that ..... .... .. .... has permission to .............. plumbing in the buildings ............... 77 at .... ..North Andover, Mass. 2, Fee!,.�V". Lic. No.. e ` ............. -PLUMB/ING INSPECTOR Check # Ilnj,7 7765 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING n 07-4 - City/Town:Acloyeol- , MA. Dater -957-0$ Permit# %746� Building Location:860 T Wi/te �d'C 6t etre plbaL— Type of Occupancy: Commercial Educational ❑ New: ❑ Alteration: ❑ Renovation: ❑ Owners Name: KS Industrial ❑ Institutional ❑ Residential ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ CIVTt I�cG� Installing Company Name: 7here-tew /olym6o g 4 Address: !Qf;e'wl 44- City/Town: 4(/cwfjWow17— State: Busin6ss Tel: 97c*,— a Ss— o867 Fax: 5' 78 —YP—o27%3 Name of Licensed Plumber: , Check One Only Certificate # ❑ Corporation ❑ Partnership ❑ Firm/Company 11YJURHIVIiG L-UVtKAvt: 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 f13 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 Agent Owner E-] Agent E] 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 City/Town 'Master APPROVED (OFFICE USE oNLv► ❑Journeyman C of L'censed Plumber License Number: 133 �� • t • • --------------------------- • • • • • .-----------�-------------- • • - --------------------------- MM MMM N MWOMMMM • • • • t------MM------------------ Installing Company Name: 7here-tew /olym6o g 4 Address: !Qf;e'wl 44- City/Town: 4(/cwfjWow17— State: Busin6ss Tel: 97c*,— a Ss— o867 Fax: 5' 78 —YP—o27%3 Name of Licensed Plumber: , Check One Only Certificate # ❑ Corporation ❑ Partnership ❑ Firm/Company 11YJURHIVIiG L-UVtKAvt: 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 f13 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 Agent Owner E-] Agent E] 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 City/Town 'Master APPROVED (OFFICE USE oNLv► ❑Journeyman C of L'censed Plumber License Number: 133 �� J Z 2 �c>g Date.................................. "`° '• "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING -c This certifies that ....... . [:G% has permission to perform .......�c C �� ............................................................. wiring in the building of �............... c�.............. : �-.. ►moi �./�r�i��'................... at ................. IJ/Z 1��'F . ...................... , North Andover, Mass. 2 f.-' � Lic. No....�.?'.�7, ........ �. Fee ................ ......... .....;,.. ......... .........f...... . ELE RICALINSPECTOR Check # ��r --moss.ovsrvvcaun Namor massachusettS Officia]Use Only Department of Fire Services Permit No.�� BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/07] Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ' TRI All work to be performed in accordance with the Massachusetts Electrical Code (Mw),527 �ALOWORK (PLEASE PZWT KINK OR TYPE ALL INFO c J MA"TION) Date: City or Town of: NORTH ANDOVER BY this application the undersigned gives notice of his or her intention to perform the To the nelle trial W� Wires:. below. Location (Street &Number) Owner or Tenant I'Z - r, Owner's Address /J _ y v Telephone No. �''" r� (,o' tuVC ( I1.1(nJ(A Is this permit in conjunction with a building permit? Yes Purpose of Building N0 ❑ (Check Appropriate Bog Utility Authorization No. E3istfng Service Amps / Vohs Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No, of Meters Number of Feeders and Ampacityycri er�, Location and Nature of Proposed Electrical Work t-' fZ4 S Dark Forte A Completion of the rn7lo... table may be waived by the Inspector oWires. No. of Recessed Luminaires No. of Cei1.-Sus No. of p (Paddle) Fans ,.7-0w----7 of Lamninaire Outlets o. of Luminaires .'� ( -� R No. of Receptacle Outlets No. of Switches G No. of Ranges No. of waste Disposers No. of Dishwashers No. of Dryers No. of stet Heaters ' KW No. Hydromassage Bathtubs OTHER: S a y e K� No. of Hot Tubs Generators KVA Swimming Pool Above ❑ In- d.d. o, o mergency ig BatteryUnits6. No. of Oil Burners FIRE ALMSNo. of Zones !No. of Gas Burners No, of Detection and No. of Air Cond. Total � Initis ' Devices Tons Beat No. of Alerting Devices "Imp umb r Tons Totals:. " o. of Self: Contained Detection/Alerfin Devices Space/Area Heating KW Local ❑ Municipal ❑ Other HeatingA ppiiances KW Connection Security Systems:* Ballasts . No, of MotorsTotal HP 1� S 1 UC�ti Si'IZ v� Wiring: o, of Dei No. of Devices or o ogpq Estimated Value of Electrical Work: 2-cl $ db, W Attach additc°ria detail if desired or as required by the Inspector of Wires. Work to Start: --% (When required by municipal policy s --L-L 6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no the licensee provides proof of liability Permit for the performance of electrical work may issue unless insurance including completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force d has exhibited proof of same to the CHECK ONE: INSURANCE ❑ BOND OAR Permit issuing office.. I certify, under the pains and penalties o eT (Specify;) G (� r`t i) ` fP ry, t the information on this app ' ation is true and complete. FIRM NAME: / rw e Licensee: L c LIC. NO.: 130 F -7A of applicable, enter exempt " in the license number line.) Signature LIC. NO.: Address: /SSA c� (r r7�r j Int �A /yl Bus. Tel. No.�� ii^ 31S 3�3/ *Per M.G.L c. 147, s. 57-61, security work re es D Alt TeL No.: OWNER'S INSURANCE WAIVER: I am aware that the does notSafehav'e,the cense: Lic. No, required by law. By my signature below, I hereby waive this re liability insurance coverage normally Owner/Agent requirement I am the (check one) ❑ owner ❑owner's agent Signature Telephone No. PERMIT FEE. $ The COMMOr K,ea th of Himuchuse& r~j °t• Department of Lndustrial Accidents Office '' of InvestQ atsons o ti.! 600 Washingars Street ` Bosto►t, MA 02111 {� www-n=s gov/dia . Workers' Compensation Ltsura.nce Aff davits Builders/ContractorsJiectricia�,f A licant Info>;maiion ambers Name (Business/prganizatiorondividlusl);_ j PleasePrint Legi6 S f! t2` Address: 1 S T e CL a 2 City/State/Zig: Phone # _ - 1 3-7 Are o employer? Check thea ro pp priate boz: ' 1. employer with op 4. ❑ I am a ject (required): employees (full and/or part-time).* 2. ❑ . I am: a sole proprietor. or have haired the sub -contractors construction Iisted 7[D partner- ship and have no employees on the attached sheet 3 deling These sul;-contractors have workingfor me in an y capacity. [No workers' comp, insurance S. Q Demolition' worker S' comp. insurance. S .We are a corporation end i#s - 9' Q B ng addition 3. ❑required.] 1 am a homeowner doing all work myself. officems have exercised their 10. Electrical repairs or additions right of exemption per MGL I l.Q Plttrnbi L ng rept. [No workers' comp. msuran..e or additians c..152, § I (empti d we have 12 Q Roof repairs required.] .employees. [No workers' oomp. insurance required.]. ' 13.[],pthcr 'My applicant that creeks bout # 1 must also fill l out the section below shownng their worked' bo t who submit this e{iiiiavit indiondng mpensation pof icy information omn,,wnrs they are loin all wofk lCorttractona that cheok this box musta(taebed an g and than him-omside contractonr must submit a new afi'ulavit indi suc X1 additional shoe" showing sub the risme of fhc8 h ,., ct=andtheir work= . urn. an ernpw yer Zhatls rp ' - r .I.T ...-gun. gun. vrding:workers cornpensatiotl cnsrcranee or infornradon, f nV enrkyem Below ir.the policy amd joh site Insurance Company Name: � Policy # or Self -ins. Lic. #: Expiration Date -2:12 3 - ZZ,! > Job Site AAdrass.: 20 -2 RN �t c 2c Attach a copy of the .workers' ot. l city/Stat, col ��' d cisco n pecsation policy declaration page (showing the policy number a Failure to secure coverage ad expirsfioa date as required under Section 25A of MGL C. 152 can lead to the imposition of criminal penaki fine up to $1,500.00 and/or ane -year imprisonment, as well as civil penalties in the form of a STOP WQRK ORp es of a of tip to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded td the Offim of d a one investigations of the DIA for insurance coverage verification. • reoy ceruiy under the pains and penalties 0f perjury that the information provided above is acre and corrr4 SiPnatr.tre: �,� Date 5' Z Z -U °hone #: Ofj`icia! use only. Do not write in lfiis area, to be Completed by efty or town officio( City or Town; Permit/License # Issuing Authority (circle one): I. Board of Health 6. Other 2- Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Persom Phone 4- F Information and Instructions `Y Massachusetts General Laws chapter 152 requires all emp 3oyers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An ea ployer is defined as "an individual, partnership, mc>dia6an, corporafion or other legal entity, or any two or more ofthe`foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or fhe receiver or tntater•of an individual, partnership, association or other legal entity, employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair wclfl� on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local iiedusing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any appi;cant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MOL chapter I52, §25C(7) states "Neither the commonwealthnor any of its poli ical subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) land phone mznber(s) along with their certificate(s)' of insurance. Limitrd Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no. employees otherthan the members or partners, are not required to carry workers' compensation insurance. if an LLC. or LLP does have empioyees, a policy is required. Be advised that this affidavit.may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign, and date the affidavit The affidavit should be retanaed to the city or town that the application for the permit or license is being requested, not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you .are required to obtain a workers' compensation policy, pieasrcall the Department at thcnumber.listed below. Self-insured companies should entut mir self-insurance•.iicanse number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Depar melt 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 permittH=ise number which w,iII be used as a reference number. in addition, an applicant that. must submit multiple permitliicense applications in any given year, need only submit one affidavit indicating•currertt policy inbrmafion (if necessary) and ander "Job Site Address" the applicant should write "all iocations in (city or town).." A copy ofibe affidavit that has been officially stamped or marked by the city or town may beprovided to the 1. . applicant as proof that a valid affidavit is on file for fuiure permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e. a. dog license or permit to bum leaves etx.) said person. is NOT required to complete this affidavit The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address, telephone and fax number. . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Lnvesfigaiions 600 Washington Strtreat Basion, MA 02111 TeL # 617-72-74900 Ext 406 or 1-877-MASSAFE Revised s-26-115 Fax # 617-727-7749 www.man,crovldia CERTIFICATE OF USE & OCCUPANCY Building Permit Number 700 (5/28/08) Date: Auggg 14.2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 800 Turnpike Street — Suite #202 MAY BE OCCUPIED AS No. Andover Pediactrics — Dr. Office IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North AQdover Pediactrics 800 Turnpike ST North Andover MA 01845 Building Inspector 4 r' �4 .(u 9 O "Cl O FM4 O O 6 z V a% Ocm N N �m3 S •' C jto 0*4.2 Cc ce E m o.C'3 ` N m cc¢ N dC.0 CD 'EA: o cc '� Z c ao m N C = O F- r0.. W_C Wim= LL O m .. C ml •N �O.tuj Cog O G O w ,N C.3 •m O ® C N� d a m > m co O CD . L O Z °o CL O y O O O O! i O M E m m L O O d. ~ CD ca Ca O � O L cc O O=. a cM Q c ca = c 0 � ev .OZ . O y0., C CD Ll) y cc c �C c CO)CL 5 LLI CA uj U) ce W LU 19 LLI //WU� Y/ A z N 1 w a0r7 ° Q o "c c i w, o ;`w a c 7 w° cn w° ice cn t cG w as cn cn O FM4 O O 6 z V a% Ocm N N �m3 S •' C jto 0*4.2 Cc ce E m o.C'3 ` N m cc¢ N dC.0 CD 'EA: o cc '� Z c ao m N C = O F- r0.. W_C Wim= LL O m .. C ml •N �O.tuj Cog O G O w ,N C.3 •m O ® C N� d a m > m co O CD . L O Z °o CL O y O O O O! i O M E m m L O O d. ~ CD ca Ca O � O L cc O O=. a cM Q c ca = c 0 � ev .OZ . O y0., C CD Ll) y cc c �C c CO)CL 5 LLI CA uj U) ce W LU 19 LLI //WU� Y/ TOWN OF NORTH ANDOVER Building Department North Andover Ma CERTIFICATE OF FINAL COMPLETION Building Permit Number: Permit Date: Project Title: North Andover Pediactrics- Tenant Fit -up Project Location: 800 Turnpike Street, Suite 202, North Andover Ma Owner: KS Partners, Suite 102, Billrica, Ma Nature of Project: Tenant Fit -up for North Andover Pediatrecs Area of responsibility: Entire Project 7 Architectural F7X Structural MechanicalF7 I, Richard H. Casale , Massachusetts Registration No.: 2020 , being the Registered Professional Architect responsible for the construction of the above referenced areas of responsibility on the project do report that my final site observation was made on August 15, 2008 with a representative of Parsons Commercial Group and that the tenant improvement is ready for the intended use and I hereby certify that, to the best of my knowledge, the work has been performed in accordance with the approved plans dated 05/04/08 and 780 CMR, the Massachusetts State Building Code. '� 4d ff &,,a Signature and Seal ARCyjT�c H Cq�q� F c� gpSZOP1� n LTH 13VO" fl16l�Q Date TOWN OF NORTH ANDOVER Building Department North Andover Ma CERTIFICATE OF FINAL COMPLETION Building Permit Number: Permit Date: Project Title: North Andover Pediactrics- Tenant Fit -up Project Location: 800 Turnpike Street, Suite 202, North Andover, Ma Owner: KS Partners, Suite 102, Billrica, Ma Nature of Project: Tenant Fit -up for North Andover Pediatrecs Area of responsibility: Entire Project F� Architectural Structural F1 MechanicalF7 I, Richard H. Casale , Massachusetts Registration No.: 2020 , being the Registered Professional Architect responsible for the construction of the above referenced areas of responsibility on the project do report that my final site observation was made on August 15, 2008 with a representative of Parsons Commercial Group and that the tenant improvement is ready for the intended use and I hereby certify that, to the best of my knowledge, the work has been performed in accordance with the approved plans dated 05/04/08 and 780 CMR, the Massachusetts State Building Code. iv&ta Signature and Seal_ y'�AEo aRcyIT H. No. 2020 BO.NI MAJ �q( %H OF MPS d -e '/s�/o & Date 4 RHC Professional Association ARCHITECT 76 Wright Road Hollis, N.H. 03049 TEL. 1-603-465-7133 FAX. 1-603465-6031 July 10, 2008 Mr. Gerald A. Brown — Inspector of Buildings Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 Re: North Andover Pediatrics Suite 202 800 Turnpike Street North Andover, Ma Dear Mr. Brown The purpose of this correspondence is to clarify the location and size of the Handicapped Toilet within North Andover Pediatrics Suite 202, reference the attached SKA-2 which indicates a handicapped toilet within the parameters of Section 30.7.1 Figure30d of the Architectural Access Board, page 123. Please be aware, that it was the original intent of the Owner to have this toilet room as the Unisex Handicapped Toilet, which is located near the laboratories and Examination Rooms. I trust that the above meets with your approval. If you have any question concerning the above please contact me. Very truly yours RHC Professional Association Lam: ,4,-4 Richard H. Casale, AIA President Date... ^ "`" TOWN OF NORTH ANDOVER •..p' ..a e L 9 PERMIT FOR WIRING This certifies that ............. �. .....?zX. C .T.......� ............... r _ has permission to perform!` �G 11I/T r T 0 sL .......................................................................... wiring in the building of ...... C4ti►....f3�S�'�' at ..........a„ ....../ZITi Pif"--;..........`..? ............�.. , North Andover, Mass. �o Fee -t -7-5.---q.. '.Lic. No. r f? ........... ..... ........ ........+. ELECTRICAL INSPECTOR (r� Che..ck # .4 7 4�� � 7 �► Irv' �i THECOMMONWE9LTHOFMASS4CHUSEM Office Use only DEPARTA1UU0FPUBUCWEIY BOARDOFFIREPREVEAWONREGUZATIONS527CW l2:Gb Permit No. Occupancy & Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRIlVT IN INK OR TYPE ALL INFORMATION) Date cA — �3 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address r.". A e, L A u-,' ,e VU6 To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes a No (Check Appropriate Box) Purpose of Building �%>re p',rL �Q,�4 t .� 6o4 Utility Authorization No. _ Existing Service Amps�Volts Overhead M Underground M No. of Meters New Service Amps / Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool AboveBelow Generators KVA KVA round round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a -Vo. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP K/'\qt 1011-� �"Icif Eglloore Insutaa=CowrW- Rusuanttothe wgtme nff&ofM Cermal Lam Ihave acunatLiabl7dyhmua<neP>lityincltxlQlgCorrple�&Opew=CC)mng,txitsstbq%1Wegtrivalai YES NO Ihave-gtnf EdvandpwfofsametodrOffim YES (�1Ct) ifyoutow chedodYES, pkaseirrlct drvpeofcoverag,�by d RACE aE] BOND OTHER E] pinse may) Estnr�dValueofEl�ical%k $ WodcroStart hrspec>ionDa[eReytlestdd . Rough Si9rVdRFinal ur A �talttesafp�tay ` j e �t LcenseNo.Lioff ` `� Sigl a Lioa>SeNo /f BusmessTel No�I7� Address�G s 7 Q/ S i� q cz. r e 4c c J l At Tel Pb. OWNER'S INSURANCE WAVER; I am aware thattheLioam doesnothave theinsurancecowW arils substantial equivalent as required byNt%mda>serLs General Laws and that n -y signahue on this pemut appli=cn waives dw M# M-01 (Please check one) Owner Agent Telephone No. PERMIT FEE $ Signature of Uwner or Agent 1tiL' UU1VllVU'V /IL'""" Ur Au —.— ,,,,., DF.WR7NWOMBIK' PUY Permit No. _ -r 7 9C� BOARDOFFMPREVEMONRWJAA 70NS527QM IZO moo ® Occupancy & Fees Checked C APPLICARIONFOR PERNIlTTO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street Owner or Tenant To the Inspector of Wires: owner's AaareSS Is this permit in conjunction with a building permit: Yes M No a (Check Appropriate Box) '.^ 4 Purpose of Building Utility Authorization No. Existing Service Amps�Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above M Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bunters FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tom No. of Detection and of Disposals No. of Heat Total Total ,)No. Pumps Tom KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• h &=XeGmage Pla&=k)thetaV=-0ftd7V ectu sGn2alLaws Ihneaanatliaifty a==FbLysdAgCarr critsmbamtWcquivaiai YES El NO IhaveshminedvaldptoofofsmmiodeOlim YES ff}whmd=JztiMpk=i dcaa Ihegpeof wmWby dradQW the bmc INSURANCE BOND 011iER WbikioStalt SWnedunLA FIRMNAME ftm*y) E4imfimDab Estirrr�dValieofl7acmtal Wodt $ RataFwW' LioelneNo: M'SMJRANCEWA M ;latnawaet uftLioernedoesmthmlheirnua n critssibAaml rtdthatmysgr�aernth'spt�ritapp5catirnwaivestti4iagtianait qivWatasm#WbYMamhmtlsGenaalLaws Please check one) Owner 1:3 Agent Telephone No, PERMIT FEE S signature of Owner f4gt- � � 0 & S = / 8 - 0 JIM L 1VVYltJly rrit A"n yr tnr>t arit,cituaa.i �� �•••w ��. . , r� DF.PARTME TOFPUBLJCSAFE77 Permit No. B0ARD0FFIREPREVFNII0NRDGUlAT70NS527Qt1R121X1 7�1_ Occupancy & Fees Checked APPLICAHONFOR PERMUTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 5'" .6-- c - Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ` 00�j) \/, c, Owner or Tenant Ever 99 lop- Owner's oiZOwner's Addre�sw` T 7 i, -G A- AS-" ye ' Is this permit in conjunction with a building permit: Yes [ZfNo (Check Appropriate Box) Purpose of Building ( rj r L Utility Authorization No. Existing Service Amps��Volts Overhead 1:1 Underground a No. of Meters New Service AmpsVolts Overhead Underground Q No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets S k j No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures /L Swimming Pool Above 11 Below Generators KVA round ground ri No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total 1;10. Tons of Disposals No. of Heat Total Total No. of Detection and / Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW a Connections No. of Water Heaters KW No. of No. of Signs Bailasis Hydro Massage Tubs No. of Motors Total HP 30_(F (e Alt! ncelObveage, PdauxtIDthere4z natcthlassitlusMCernWLaws aatuaitbobt*bsratoePb6cYit>ditCanplet Cov>2WaritssubanWecltvalriaR YES Er NO a suhritbdvaBdptoofafsare1odrC1 = YES rid IfycuhawdrdodYFS,pleMvxiralethet}'peoioove Wby Stat 5 S -vim. QC,a "t D (.4-\ AnN 1 ee, I J1_ Sigrwe t� /h/0 $ FuW Lio w�b 1 -*?z--, Ll Busk=TelNa 9 S -3 Fs 7 1 C /, .J1L+I / - 1l'I. Ak dNaL ��R'SINSURANCEWAIVE ;IanimmdutheLioa�ed mmtharetheinstaareoa uWcrilss bmr aletltriv inasmgmadbyMandumc iawi-aws ueoilthisperm[ waivesalismgzmmt one) Owner Agent Telephone No. PERMIT FEE $ lgna ure o Owner gen '� ROV94" 0 k- IF, - .6 5-- .01 F�-Ixl 6299 Date ...... L"6.... °:,"`° '• ."� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �T S�c�n Ti This certifies that....................................................�.:.S .,�!:��=...Ps'' ....s... � has permission to perform ... T.1/. ....?��...... i 6 wiring in the building of ......�' .= ... r!-!`1...�. .... at ................... . North Andover, Mass. /S3 3C Fee ...7.... s �.... Lic. No. X6-3 5.`...............e� r , _ . .�... � !.... ELECCRICAL INSPEC`1`0 ' Check #�� 0 A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2, q 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 ININK OR FALL INF RMATION) Date: City or Town of: , �f�[31%To the Inspector of Wires: By this application the undersigned fives notice of his or her intention to perform the electrical work described below. Location (Street & "her) Owner or Tenant ( '4-m i Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Yes ❑ No Telephone No.Xl/„-_Wj) (Check Appropriate Box) Utility Ay thorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security and or Fire alarm systems Com letion of the following table may be waived by the In ector of Wir No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans es. 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. o mergency 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 Initiatin 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 Kit Security Systems:* No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electricalork: W (When required by municipal policy.) Work to Start: / Q 6 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 trite and complete. FIRM NAME: ADT Security Services, Inc. LIC. NO.: 1533 C Licensee:Jonathan lapham Signature LIC. NO.: 2345D (If applicable, enter "exempt" in the license number line.) /,- Bus. Tel. No.: 603-594-5900 Address 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable, enter the license number here: SS CC 001684 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 ftnature Telephone No. PERMIT FEE: $ NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: Hf4ILLxE. %7V5 /Oral wl1GbI6/t C,✓1t)v� ADDRESS: 600 lv►2n>d��l!r� sylZ�£ f- v s' 30� ZONING DISTRICT: TYPE OF BUSINESS: H Q G o nJ st,) i., TA u I - BUILDING LAYOUT PROVIDED: AVAILABLE PARKING SPACES: /m U C t ( ZONING BY LAW USAGE:YES NO BUILDING INSPECTOR SIGNATURE Revised 11.5.04 W SMSS FORM FOR MWN CLERK SCO--T-U PA) %,A.5 ,, i }-,�- t o D Location No. Date01 NORT" TOWN OF NORTH ANDOVER 3?.• • O Certificate Occupancy $ of CM� Building/Frame Permit Fee $(/ v Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ) a [FF Check # A4 r 18'179 Buildinb 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 1252 M -21A Who Section for Official Use Onsgo B PERMIT NUMBER: / DATE ISSUED: �j SIGNATURE: L2—�-- Buildi!&Commissier or dBuildin Date `A 1. I Property Address:) 1.2 Assessors Map and Parcel Number �' Map Number Parcel be 1.3 Zoning Information: 1.4 Property Dimensions: Zmin DistridProposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard ReqWred f) Mvide Required Provided Rc Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infbrroation: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone .. ... .. Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record 1 %� ame (Print) Address for Service: Signa Telephone 2.2 Aut Lgent A �� 6C V� Name Print Ad ress for Service: ^ �[ Signature Telephone -1 MM OREM 3.1 Licensed Constructs Not Applicable ❑ dress License Number u Expiration Date Not Applicable ❑ 5egE,i;'e 0 TelephhHom Improvement Contractor Company Name Registration Number Address II Expiration Date Signature Telephone 0 X z z M t .I D ... . 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 SEC"I�ION � � )��� :5IUD 5.1 Registered Architect: Address: Name: Address Signature Telephone r Company Name: IResponsible in Charge of Construction Not Applicable ❑ Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone r Company Name: IResponsible in Charge of Construction Not Applicable ❑ sx7T74TIViwi��,�]n, A71 11' M1 :!,,, N 4�. PAF New Construction ❑ Existing Building Repair(s) Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: j Lo 7 veof I &\ A I4 ❑ A-1 0 A4 ❑ A-2 A-5 BUILDING AREA EXISTING if applicable) PROPOSED I Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ i SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 18,-`V v —_ as (honer of the subject property Hereby authorize _ _,kw l to act on My behalf, in all matters relative two work authorized by this building permit application f X 1M Signature of r Ddte USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A4 ❑ A-2 A-5 ❑ A-3 ❑ 0 1A IB ❑ 0 B Business 2A 2B 2C 0 0 0 C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ 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 ❑ ❑ ❑ 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 I Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height (ft) independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ i SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 18,-`V v —_ as (honer of the subject property Hereby authorize _ _,kw l to act on My behalf, in all matters relative two work authorized by this building permit application f X 1M Signature of r Ddte L " ��`�' W J,- ,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 Mi Print Nam Signa of Owner/Agent Date 3 Item Estimated Cost(Dollars)to be Completed by permit applicant$~#max FF C 1 1. Building dd (a) Building Permit Fee Multiplier 2 Electrical ` o r (b) Estimated Total Cost of /0 Construction from (6 3 Plumbing Building Permit fee t,l X (s) 4 Mechanical (HVAC) 5 Fire Protection t 6 Total (1+23+3+4+5) C Check Number ` ,f75 J3i+"'.+( �t n 4kl k`^ J x t.y'`l7Yid +tc3r c r L ,�, 1 ! S +x sk LSA i -t�' - x{ & C' `' L`i 1*-. t� i{>.s.. - ';r: t. fnA,.rz / �t a i^ ay �,.: ra r a s.)t'. 6,.?rN. �1S'G-;st'Si .fi':i; el,ySra F ::%ft, 6v." 5'r.,�„�h�' y9 ;iMc: }�". c,•�� '(t,gr �r� R L'` yyis,tf i{StN:.K;;. +t_y..3 �i45�>S'x`31�c,�C°, i r 4zY -.0 t..��l.-"..•{"':.. l .<yt {vin ,Y.v: , ..v � �c'/'.. �f+fi' ¢�'. $�'�! a T$ t'4,y'�Az�} .�..t�k'�! .�, �'' d,{k' .!�.r 9 �.`�Lw.,4��� � r ,'1td'� . r. .,.p�'�,1.-f•v�`•u�t .. ,yr pr X h. ;. f°ft's' ��24':t �T,y�,I mt,,"�Y. G, �t M� - S[•'-A�'�S ��+... t. f+dt � �".t"'�`'' �,�Y`�y',G r 7 { '`(, ��'Yt'�M. '�r'C'ihe �� �,}kir'.Jq tV� `F..a} NO. OF STORIES S BASEMENT OR SLAB SIZE OF FLOOR TIMBERS l 2 3 SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS . SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 5 - S. .r��i�Y �! P.it%.,'% ..f. .. xx�,s . .. ....�:.:,�caF tF�-xr: a. •fir„fir. ,,.. 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 LOCATION: Assessors Map STREET ( ' / p 7 APPLICANT FILLS OUT THIS SECTIO OFFICIAL USE ONL LRECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVE WAY FIRE DEPARTMENT PHONE X01110� PARCEL___ LOT (S) ST. NUMBER �;_X Ad3— RECEIVED BY BUILDING INSPECTOR DATE RevInd ffiff Jm 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: `i 7� (Location of Facility) Si atu of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Ofte of Invesdgattons Boston, Mass. 02111 Walsers' Compensation Insurance Afidavit Warne . Please Print I am a horrteawrter performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I an an employer pmvidng workers' for my emplayees working on this job. Irlsurarm Co. POIM S Fdkre to o mos covarmpa m rwMrsd urdw Socllon 25A orMGL 152 can land to fha krgmg n d atonal pw alm or.a fine up to $1,5w.w andlorone yeas'Imprbamiaeu_nwd.as.cbM4mnm les JoJbsf=dASTAP]ItlMOFMipsodafloed.i;lr AWAANgowmL I understand that a copy d this sWanent maybe forwarded to the Oft'be d Invedge m of the DU for aoverapa vwrc,@ m. l db hereby Ce * unobr pie OfpSgwy dw the #*MWft provWed s !s en0 caned Slgrtature % E Print Offk w use only do not write In this was to be completed by dty or town drldM' CRY or Town pin jinn l]Check X hnmedlefe n3aponss /e raquiad 13 BuN&V Depta L k nBkq Board C3 Selectmen's MeConfect person: Phone HeaNh Deparhnent Other BOARD OF BUILDI G REGULATIONS License: CONSTRUCTION SUPERVISOR Number SCS 068271 BI rthdate ,08/0911955 ' Expires -0810912006 Tr. no: 676.0 } ,.a Restricted:, 00 JOHN W PETERSEW 246 #1 ESSEX ST,� ' f SALEM, MA 01970` Commissioner / 0 Y/ m m C m m CA CA EP v. y — C � O � �. 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K E -5-t ZONING DISTRICT: TYPE OF BUSINESS: k�1 P/VO 7/-019-1 BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: -e -t-c s S ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE NORTH ANDOVER BUILDING DEPARTMENT 27 CHARLES STREET Tel: 978-688-9545 Fax: 978-688-9542 DATE:—c>2//o /o NAME �a TR c �� � � 1© � �- �r 4v c7/s ADDRESS ZONING DISTRICT: TYPE OF BUSINESS: / / ie of l C/9- I —8 1 ) I I /vq O 4T1 G `2 BUILDING LAYOUT PROVIDED: AVAILABLE PARKING SPACES: A ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE Location ©� V r U I No. Date /� d I Check # 8 I 532 TOWN OF NORTH ANDOVER Certificate of'Occu'�ancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL / 'Building Inspector TOWN OF NORTH ANDOVERUIELDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Sechon for Official Use Onln � : F BUILDING PERMIT NUMBER: DATE ISSUED: CV2 SIGNATURE:141�" z.,/ Builft Commissioner or of Buildings Date P. U,..' 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ��r�Pr � Ol e% C)J 0 L Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Re 'red Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ J i.S Pn •,.4�a+'tR ^ .,Yr h7i t�t .v.. � ,i` ?1:; 7 •.}.>, i✓- lr,�x �-':� Sil3S�;��`.v 2.1 Owner of Record �M m LLL Name (Print) Address for Service: ( j -`7� 9-3�— SignatureTelephone R P- Al; 2.2 Authorized Agent Name Print Address for Service: i 7� Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ M��w5 coNS-TR�A Ion LS Address License Number © s A iD D [-F i A Dlg41 ice � u !/'12, Q �nr o! 17 4) -� 7 t� _ ' e�1 Expiration Date re Telephone 3.2 Registered H e m ov ent for Not Applicable ❑ �n Company Nam Registration Number Address Expiration Date Signature Telephone _K -4 Z 0 v n M CA) IV 0 M z z /wM 0 n r v M r r P1 Stgnature Telephone N1 Pf CON E-19-tALT10 Company Name: Kesponstble in Charge of Construction Expiration Date Not Applicable ❑ 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 ....... ❑ SECTION fOAT 5-,P)ROFSSI+i31AL)d)5+t itlN SARVI+CtS't B1Jli)IF1�i41�iD 11�J'I t3)ttS St;'1D `. 5.1 Registered Architect: Name: Address Signature Telephone Area of Responsibility Name: �DNpDn) D���`` N� Re Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Expiration Date Signature Telephone Area of Responsibility Name Registration Number Address Expiration Date Signature Telephone Area of Responsibility Name Registration Number Address Stgnature Telephone N1 Pf CON E-19-tALT10 Company Name: Kesponstble in Charge of Construction Expiration Date Not Applicable ❑ New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: a( e d -e rAy . a d a r12,9 . rr� k�C�+f t�X�s�`��1 `F � X�Nr e S IA 1 B ❑ ❑ BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floors Total Area s Total Heiaht (ft) Independent Structural Engineering Structural Peer Review Rapired Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 D A4 ❑ A-2 ❑ A-3 A-5 ❑ ❑ IA 1 B ❑ ❑ B Business H, 2A 2B 2C ❑ ❑ D C Educational ❑ F Factory ❑ F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional D I-1 D I-2 ❑ I-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 D S-2 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ 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 Floors Total Area s Total Heiaht (ft) Independent Structural Engineering Structural Peer Review Rapired Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date Ea D f=e- K -51 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 %A $ 10 Signature of Owner/Agent Date Pir Item Estimated Cost (Dollars) to be R Completed by applicant permit 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee t.l X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) S Check Number .. ... ... ..... . .... RINI NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TTMBERS IST 2 ND 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CBIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE sq 79 a P Ae p o Q U) Z W H U) QLU J LU 20 Of D OiZ2 gz oo W co �2 Vp O N M O m 2 LL J) N N O Z 'n "(0 O o � U p � a ai iii m iu v Z W J m P Ae p o Q U) Z W H U) QLU J LU 20 Of D OiZ2 03/18/2002 14:34 19785369962 EVEREST PARTNERS OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER 041 CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT LOCATION., 90V098014rg Q2. NAME OF ■ ?YLi!► NATURE OF • PAGE 02/02 IN ACCOR A CWITH LA 116 OF THE MASSACHUSETTS STATE BUILDING CODE, � ,A REGISTRATION NO. 779 j_ BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HERESY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL N STRUCTURAL U MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE. AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL. PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS.TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings; samples and other submittals which are submitted by the contractor in acmdance with the requirements of the construction documents. 2. Review and approval of the quallty.control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, ,generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents, PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AST THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OC P G AT E SU CRI BED AND S M FORE ME THISDAY O 20 -.,X NOTARY PUBLIC MY COMMISSION EXPIRES DIANE J. PAGE /VZMM Public - New Hampshire Commission Expires June 20, 2006 The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print = am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity t I am an employer providing workers' compensation for my employees working on this 'ob. W] Com ony name: Address City: Phone # Failure to secure coverage as required and/or one years' i went understand tha e�.� oth fte= I do herby ce#ify under the Print name Official use only do not write in this ❑Check if immediate response is Z( 25A or MGL 152 can dyad to the imposition of criminal penalties. of a fine up to $1,500.00 the farm of a STOP WORK ORDER and a fine of ($10o.o0) a day against me. I Adr to the Office of Investigations of the DIA for coverage verification. 01 111 that the information provided above is true and correct. -Zt be completed by city or town official - I . Building Dept Contact person: Phone 4 WORKMAN'S COMPENSATION # ❑ Building Dept ❑ Licensing Board ❑ Selectman's CfFice ❑ Health Department ❑ other ACQRDo E 1/04/02 PRODUCER AON RISK SERVICES, INC. OF NEW YORK TWO WORLD TRADE CENTER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, NEW YORK, NY 10048 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING COVERAGE . COMPANY A Twin City Fire Insurance Company LEITER INSURED COMPANY B Genesis Consolidated Services Inc. LEITER 21 Worthen Road, 2nd Floor COMPANY C LEITER Lexington, MA 02421 COMPANY D LEITER COMPANY E LETTER tt ,,p 'G 51 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) ALL LIMITS GENERAL LIABILITY GENERAL AGGREGATE ❑ COMMERCIAL GENERAL LIABaM PRODUCTS-COMP/OPS []CLAIMS MADE ❑ OCCUR AGGREGATE PERSONAL & DOWNERS s CONIRAC`MR•s PRar. ADVERTISING INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MEDICAL EXPENSE (Any o� on) AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS - — BODILY INJURY (Per person) $ ❑ HIRED AUTOS ❑ NON -OWNED AUTOS BODILY INJURY (Per accident) $ ❑ PROPERTY DAMAGE $ GARAGE LIABILITY Any Auto AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ❑ EACH ACCIDENT ❑ AGGREGATE EXCESS LIABILITY ❑ Umbrella Form ❑ antER THAN UMBREIIA FORM EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPiAYERS' LIABILnY The Proprietor/ Partners/ 0 Incl- Executive Officers Are: ❑ Excl. IOWBRC488-04 01/01/02 01/01/03 X WC STATUTORY LIMITS OTHER EL EACH ACCIDENT $1,000,000 EL DISEASE - POLICY LIMIT $1,000,000 EL DISEASE - EA EMPLOYEE $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Coverase alies to all em to ees assi ed to Certificate Holder throu a Professional Em Io er Arran ement P Marus Construction Services, Inc. (Div. #1) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE 70 Maple St., THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR P.O. BOX 745, TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO Middleton, MA, 01949 OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /J ACORD® , (E, " ,fi ISSUE 1/04/02 FRODUCFP AON RISK.SERVICES, INC. OF NEW YORK TWO WORLD TRADE CENTER THIS CERTII9CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, NEW YORK, NY 10048 ` EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING COVERAGE COMPANY A Twin City Fire Insurance Company - _. ... LEITER INSURED COMPANY T; Genesis Consolidated Services Inc. LETTER 21 Worthen Road, 2nd Floor COMPANY C LEITER Lexington, MA 02421 COMPANY D LETTER COMPANY E LEITER Tf.� yny ._ 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) ALL uMn's GENERAL LIABILITY GENERAL AGGREGATE - ❑ COMMFRCIALGENERAL I.IABMnY PRODUCTS-COMP/OPS ❑C1AIofS MADE ❑ OCCUR. AGGREGATE PERSONAL & DOWNERS aCONTRAcroR•S PROT. ADVERTISING INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MEDICAL EXPENSE (Any one on) AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT $ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per person) $ ❑ HIRED AUTOS ❑ NON-OWNED AUTOS BODILY INJURY (Per accident) $ ❑ PROPERTY DAMAGE $ GARAGE LIABILITY ❑ Any Auto ❑ AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT ❑ AGGREGATE EXCESS LIABILITY El umbrella Form ❑ OTHER THAN UMBRFLw FORM EACH OCCURRED $ AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABHM The Proprietor/ Partners/ ❑ Incl. Executive Officers Are: ❑ Excl. IOWBRC488-04 01/01/02 01/01/03 X WC STATUTORY LIMITS OTHER EL EACH ACCIDENT $1,000,000 EL DISEASE - POLICY LIMIT $1,000,000 EL DISEASE - EA EMPLOYEE $1,000,0()o OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Covera e a lies to all em to ees assi ed to Certificate Holder throupofih a Professional Em to er Arran ement Marus Construction Services, Inc. (Div. #2) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE 70 Maple St. (Div. #2), THE EXPIRA'T'ION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR P.O. Box 745, TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO Middleton, MA, 01949 OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE North Andover Building Department Tei: 978-688_9845 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid, waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: SAVE- M (Location of Faci ty ---a- Signature of ermit Applicant lit ��- Da e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector fA C/) m m C/) 0 m So Cil CA CD n Z y O. O C9• O .CL H � o out CD O p CD o cl.* CD CCD O CCD CCD CO) CD CO y CoO I CD S- CA O 'O Z CD O CD 0 C CD Oq• o m o �o cn C C ?� p ? _ 4 i CA FOS0 H ti CA � o a: m 0 Hc2a� m C! m n Z co =w y cn 6" �. S. ' C N y a OCD col O m �Q 0 ZS C2 00 Cl ►� ca ; 0 ca :-F Sh CDCD :O co CD a o `ir c ILmn ��y 1•J cue 0. o: N �'7 y: a Ce `C m :� c a o� a coMv �m 0o:z � 0 y 3 s tjACD o :G � � CA: 0 =r 0 d !� o+ ate.. O Mop 41 Q� J�CJ o m o �o cn cn tb -x 4 i CA 'n P CA � n? 7d ro Ml x n 7o qn z cn 6" o M M i 0 0 c CD C I? Z Location �,/-.�— - No. 6,Y l U Date NC^TM TOWN OF NORTH ANDOVER F - w 9 * i Certificate of Occupancy $ cM �� Building/Frame Permit Fee $ s�usE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check #r / i43_ Building Inspr& 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 iT tom„ ,r3i-�.N?x'Y.i^ � d .F�$fl�' PE ,..s +s. r .,: d . z{ «mss; x r.:3n.r`..,+ • x'�Sz4 ' Cal Use Only Section for Official � x ,r , :..� .*Y�3 r, BUILDING PERMIT NUMBER: DATE ISSUED: �- SIGNATURE: ✓ ' Buildin& Commissioner/I or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 800 Turnpike street 098 10050 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard ReqWrcd Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record Everest Partners L.L.C. Cambridge MA. Name (Print) Address for Service: 617 576 2939 Signature Telephone 2.2 Authorized Agent Grub & Ellis Boston,MA. Name Print Address for Service: 617 772 7200 Signature Telephone 3.1 Licensed Construction Supervisor Not Applicable ❑ Dwight Brown 058659 Address License Number ` 38 Balcom Rd. Pelham, N.H. 03076 Li nstruction r: 3/31/2002 Date CA—'Expiration Sign re Telephone 603 635 8651 3.2 Registered Home Improvement Contractor Not Applicable ❑ Dwight Brown 110155 Company Name Registration Number 38 Balcom Rd. Pelham, N.H. 03076 10/9/2002 Addres �' L Q:�:� Expiration Date Signalure elephone 603 635 8651 S CTI(?N 4 i►01�K G+1 i PF, iS 3f f1l1 T (XItC S 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 ....... V No....... ❑ sEcTlFox d s§l , � r c +rs "o-J, ' �Q� , bft�/ r� Cr�vfNt��.���ys as e- �r/>� yy �m/rrs�yt��ryr����t� /��vs�t��+�►�r �y�a/r�Y i �ry y� .n.., , .... > chm- �1�r7L7�. [ 1V 601'1#itVL.C�#'�3{70riflw,i�A#.a7:7'SiAlli 'l,.Fr:.[Jl: viNr7JLi7 YL'.... . :... V 5.1 Registered Architect: Partridge Tackett Campbell Architects Name: 72 Broad street Boston, Ma. Address 617 338 8507 Signature Telephone c 21 Sl Ct ',P "a3Slt ia.z.13 Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Expiration Date Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Dwight Brown dba Pelham Construction Company Name: Not Applicable ❑ Responsible in Charge of Construction a New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Off ice Fit—up Brief Description of Proposed Work: a Renovate existing office suite adding (5) offices and doors and frames (4) side lites painting,.elec. 3A 3B ❑ ❑ USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ AA ❑ A-5 ❑ IB ❑ 2A ❑ B Business 0 2B 2C 11 ❑ C Educational ❑ F Factory ❑ F -I ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ M Mercantile ❑ 4 ❑ R residential ❑ R -I ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ ❑ S Storage ❑ S-1 ❑ S-2 ❑ U utility M Mixed Use S Special Use ❑ ❑ ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CUR 34: BUILDING AREA EXISTING Number of Floors or Stories Include Basement levels Floor Area per Floor Total Area (sf) Total Height (ft) Proposed Use Group: Proposed Hazard Index 780 CMR 34: IndepeAdent Structural Engineenng Structural Peer Review Rapired Yes ❑ No ❑ SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT PROPOSED Owner of the subject property Hereby authorize to act on My behalf, in all matters relative two work authorized by this building permit application Signature of Owner Date I, 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 Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be Completed by permit applicant 1. Building 20.280.00 16 , 300.00 (a) Building Permit Fee Multiplier 2 Electrical 2,000.00 2,000.00 (b) Estimated Total Cost of Construction from (6) 3 Plumbing 500.00 500.00 Building Permit fee (,) X (b) / ✓. /30 4 Mechanical (HVAC) none none 5 Fire Protection 1480.00 1,480.00 6 Total (1+2+3+4+5) 20,280.00 Check Number t,."�t:Y art } #gs�J1 �4t rc`�3P:r� #..} . t £ a.. -.`n H .,•5 `4 G`�v,..."%. s<'r.<�'rt7if Sys £u trr, j 4,N a*yF.. h rF54+.Y,. ; \[.a F�t ,�n� lE Ori_ 1 `P,.ttµ: `.i�. i. = 4_�, � � �;4W,F��:,.t'S n.7u� }ti•t YK }. 1 q�'r,.zrr° a `, �S,G'i.e °n'.fJild�:J Y }% TN�y "-.v /xato� 4_� ..xF r;oof ,Y: . ^F .'�ze .4,rAL f�4f,xt°\. .�: d� u va: ..qwf. �;y, tX NO. OF STORIES 3 SIZE BASEMENT OR SLAB slab SIZE OF FLOOR TIMBERS IST PD 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL, GAS LINE no it:'vky_J� �F wt' � „ t f` �k`.t:;3X MEMO FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT Grub & Ellis PHONE 617 772 7200 ASSESSORS MAP NUMBER 098 LOT NUMBER 0050 SUBDIVISION Office Fit—up LOT NUMBER STREET 800 Turnpike street suite 102 STREET NUMBER ..............■...um.uun....mmu.was .r.......■ .......................mound... OFFICIAL USE ONLY RECONM1ENDATIONS OF TOWN AGENTS ...............................■..d......m.m.n.....mmm....m.m■■■■o..m...o...■ DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER _ DATE REJECTED CON94ENTS DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH _ DATE REJECTED COMMENTS PUBLIC WORKS - SEWER 1 WATER CONNECTIONS DRTVEWA PERMIT DATE APPROVED FIRE DEPARTNfENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE CONTROLLED CONSTRUCTION AFFIDAVIT PROJECT NAME: Office Suites at Jefferson Park, Tenant Fit -out Kenrick Investments LOCATION: 800 Turnpike Avenue, 1 st Floor North Andover, Massachusetts SCOPE OF PROJECT: In accordance with Section 116.0 of the Massachusetts State Building Code, I, Martin J. Tackett Massachusetts Registration No: 10284, being a Registered Architect in the Commonwealth of Massachusetts, hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning the Architectural aspects of the above referenced Project. To the best of my knowledge such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, applicable standards of practice, and applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2 of the Massachusetts State Building Code. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit and approval for the conformance to the design concept; 2. Review and approval of the quality control procedures for all code -required controlled materials; 3. Special architectural or engineering professional inspection or critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in appendix B. Pursuant to Section 116.4 1 shall submit periodically, progress reports together with pertinent comments to the Building Commissioner. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Massachusetts R,/gistration Number: 102M Campbell Architects 72 Broad Street Boston, MA 02110 (617) 338-8507 (617) 338-8521 facsimile Notary: Then personally appeared the above-named on and made oath that the above statement is true. My (date) (s' ed) (date) �d/3 REN 3.�ry itttbicy K ��Yiy C nmiSs on xpire,b�,iairc ,31 9003 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Dwight Brown dba Pelham COristruction 22 gajrgm Ped 602 625 0651 Location: 800 Turnpike shrept c;iJ f.P J()9 City North Andover Ma. Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity F7 1 am an employer providing workers' compensation for my employees working on this job. Companv name: Address City Phone # Insurance Co. Policv # Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify and ains and p i f perjury that the information provided above is true and correct. Signature U--) Date 10/24/2000 Print name Dwight Brown Phone #rw� 6gGsi Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person. Phone #. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION ,. P/k\ !� 2 222 .\\ A 2 2 0 f £ � \; ,\ . 7 � � � t ■ / � 7 E � I o Q § o CL . ■ o m■ » 2.,� o m _ . � � :� /..� § �< ■ @ ■ m«o 0-■ o �\k\0) 3 9 � C c§ 2.§ 0 00ch k.} .} \ / \} . \ > co CA Z 0 ! /f z CD : k �M } \ § Mz w Cl) m m Cl) 0 CD O O CA C)� C O CO) d C7 co O CD CD CD CA 0 CCD O CD 0 R Lel n 0 Ns C ti Cao m Z ?o t� O� �Q d C T CD m G y G y N o=r m 2 > > O O m 2 m 0oo'O c m o C H n Cc o mooCD '=� n = to cc o CD co H co c 0 CD C m ca cn C H ` N 0 00 — CL 1 CA CCD to _5 f Xi y N N��= c a) CDH O CO cln CD o C CA m�: coo o �° • CD AC A ns m m C= O� 1 lonq 0 rB �7 m G w C � G M w C CL b:7- 7� lonq 0 Date ......'5� ...�.....� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .Av%T .........5 ......................................... has permission to perform .....jO � . ...... � i rc wiring in the building of .....� .................... at ....... ..!!i'd?r . ! c. F'.... r...........,........... , North Andover, Mass. Fee .:;�.. Lic. No/.�_ .!.? 9.W. ........ C- % ELECTRICAL INSPLCTOR! / Check tt 5744 1 11M Luivl[vluiv vyrV .a13 (Jr tvars.Lrii,nv.u.i 10 -.— --- —1 / DEPARDIEATOFPUBUCSAFETY Permit No. 7 4Z6(- / BOARDOFFMPREVF1MONRIsri MHONSM7aR12iXl Occupancy &Fees Checked APPILICATTON1perform PERMffTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPEORMATION)Town of North Andover To the Inspector of Wires: undersigned applies for a permi the electrical work described below. Location (Street & Number) Owner or Tenant SZeAP� Gv1./L16� IDPI- d L- R Owner's Address S G S L V e Is this permit in conjunction with building permit: Yes ENo a (Check Appropriate Box) Purpose of Building [a F) ('.L SPA Utility Authorization No. Existing Service Amps�Volts Overhead Underground a No. of Meters New Service Amps olts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outletsi l No. of Hot Tubs No. of Transformers Total �./ KVA No. of Lighting Fixtures 24� Swimming Pool Above Below ri Generators KVA round round No. of Receptacle Outlets 3 Q No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal _ Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP Slk 5 e - t n as CM&W P1a51MIDtietegzmxtbdllamdusMCeoWlaws Ihaveaamaltliabkyh>aaar=PokyitrlxkgC.aTOErstksW"#XycuhaNechedWYESpk= CommForitsavala1 YES NO Iharesthni&dv9dptoat'ofsanelDdrO� YESj�irdica0ethetyp ofwo aWby INSUI1WNCEE I ij j' BOND � oTPmt (Plea�espec�y> �i ► � 1 i.:7J"% �- � � - U G Wdk1DSt3t S -- S -vs FIRMNAME P��paNyr� c Q'� A!'/y G 1 c6 -) C Lime h , ex. U S t �Qrt Sigiraae . "Wok $ Fatal LicenseNo. � /c ) BusaleM741 Na q'.7�- S 3 Fs 3 1 z Alt Tel Na QWNER'SINSURANCEWAIVER;IamawarethattheLio wdoesnothatetheirlst mmcomWailsabslarWepvW ntasopiedbyMassadinmtxrl =Laws anddratrrrysigwkwrnlhispemlrtapplicationwanestlistac} tat %Please check one) Owner 1:3 Agent "� Telephone No. PERMIT FEE $ signature of Owner or Agent NORTH ANDOVER BUILDING DEPARTMENT 400 Osgood Street Tel: 978-688-9545 Fax: 978-688-9542 DATE: (3 BUAVESS FORM FOR TOWN CLERK ao o3 NAME: Sa�1e �• i-'Er�2r � ����� z�,�vC , 7�s�u N ��� P ADDRESS: & OO i�yrn p�Ve jfrCe-t,, 4 300 1�I�I-� h n1 �Jc�VEQ ZONING DISTRICT: TYPE OF BUSINESS: 1+ CSI BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES: u E ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE Revisal 11.5.04 BUSINESS FORM FORTOWN CIERK Location No. Date 7x 6 6 0 NORTh TOWN OF NORTH ANDOVER O��"•o •,ti0 •. • 0. 9 Certificate of Occupancy $ SDI Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # l Jyj ( -�- J Building Inspector COMMONWEALTH OFMASSACHUSETTS M I W TOWN OF NORTH ANDO VER 27 CHARLES ST APPLICATION FOR CERTIFICATE OF INSPECTION Date S ep 6 10CO () Fee Required (Amount) () No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15, I hereby apply fog Certificate of Inspection for the below -named premises located at the following address: Street andpp� �j' Number 0 0 o 1 y l w p f ke- - /'o 0 Name of Premises AILeGh Nd' L V eT F�vJd v � G C Purpose for which Premises is Used Of -F, c e- SP a C -Q- Licenses (s) or Permit (s) Required for the Premises by Other Governmental Agencies: License or Permit Certificate to be issued to Address F o e Tu r.,, c t o C Owner of Record of Building Address__E_9,) P Name of Present Holder of Certificate Name of Agency, if any SIGNATURE OF PERSONS TO WHOM CERTIFICATE IS ISSUED OR A UTHOIRIZED AGENT INSTRUCTIONS: Aizenc 0(fice PGr4) Telephone 7 7V 6 T1 - I%aa Aj ;' A/ L'1 /00 TITLE DATE 1) Make check payable to: Town of North Andover 2) Return this application with your check to: Building Dent 27 Charles Street; North Andover MA 01845 PLEASE NOTE: Application form with accompanying FEE must be submitted for each building or structure or part thereof to be cert 3) Application and fee must be received before the certificate will be issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # EXPIRATION DATE: FORM SBCC-3-74 REMISED 2/99 jmc TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECTION REPORT FORM CLASSIFICATION PASSES INSPECTION yes 0 no 0 DATED OWNER BUILDING NAME OR NO. STREET LOCATION TYPE OF OCCUPANCY - Day Care Center 0 Aud. 0 Caf6 0 Gym 0 Apt. 0 School 0 Common Victualer's 0 Liquor 0 Placeof Assembly 0 Other OCCUPANCY NUMBER (include stories # and occupancy per floor - use reverse side EXIST SIGN LIGHTED EXIT SIGNS operable 0 EXISTINGS yes 0 no 0 yes 0 no 0 EMERGENCY LIGHTING SYSTE M operable 0 dry cell 0 wet cell 0 SPRINKLER SYSTEM operable 0 gage pressure yes 0 no 0 SMOKE DETECTOR operable 0 yes 0 no FIRE ALARM SYSTEM expiration date yes 0 no 0 ANSUL SYSTEM yes 0 no 0 FIRE ALARM SYSTEM operable 0 municipal 0 yes 0 no 0 ELECTRIC EQUIPMENT PROPERLY PROTECTED yes 0 no 0 EGRESSES LAWFULLY DESIGNATE unobstructed 0 yes 0 no 0 STAIRS PROPERLY RAILED yes 0 no 0 HALLS AND STAIRWAYS LIGHTED yes 0 no 0 RADIATOR GUARDS yes 0 no 0 COMPLIES HANDICAPPED PERSONS LAWS yes 0 no 0 FIRE RESISTANT CURTAINS OR DRAPERIES HOW HEATED NO. FIREPLACES yes 0 no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS - NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY --- SHOPS FOR INSPECTOR USE ONLY Revised 3/98 JMc No- 2'15 7 Date ..... HORTM TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ....... — I eci vz (-C To C - ..... . ...... ....... ...................... w ................................ .to has permission to perform ...... RI-A.q.o ....... E �' .T ...................................... � ring in the building of ...... i.'.�h ....... I. J4. mt. � ............ at ...... ................. N h Andover, Nass. Fe F -.'tl Lic. No.S.0V .................. .�**** o h,0 INSPECTOR R... 3 -OV& WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0 P d The Commonwealth of Massachusetts Pn rnit b. �� Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12occurs+ncy S Fee oieckedlug - 00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM .ELECTRICAL WORK All work to be performed in accordance with the Massachusats Electrical Code, 527 CMR 1 :00 (PLEASE PRINT IN INR ORT�/EM�NFORHATION) Date elo City or Town ofTo the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below - Location (Stree Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes U No (Check Appropriate Box) Purpose of Building ` d�� C 0 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 w Lo ion and Nature of Propose Electrical Work No. of Lighting Outlets No. of Hot TubsNo. of Transformers Total KVA No. of Lighting Fixtures Swimmin Pool Above In- � g grnd. ❑ grnd. I_I Generators KVA No. of Receptacle Outlets No. of Oil Burners No.. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners iFIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 1:1Municipal ❑ Other Connection No. of Ranges No. of Air Cond. Total tons Disposals No. of Dis p No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW _ No, of o. o Signs Ballasts Low Voltage Wiring No. Hydro Massage Iubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a currentability Insurance Policy including Completed Operations Coverage equivalent. YES NO [] I have submitted valid pr f same to this office. Y If you have cher d YES, please indicate the type of cove age by checking the appro INSURANCE BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S Work to Start Signed under pen ties o FIRM NAME Li Inspection Date Requested: Rough its substantial E ration Date inn LIC..NO. Address AE2ZjV Bus. Tel. No. sy.7i' GI�dcl Alt. Tel. No. 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 General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent) & v 00 -ro /-.vPi 1'e e- s SPECIFICATIONS: STYLE NAME: Viking 26 Viking 28 TUFTED YARN WEIGHT: 26 Ounces 28 Ounces CONSTRUCTION: Textured Loop Textured Loop FIBER: 100% Solution Q B 100% Solution 0 B PROTECTIVE TREATMENT: N/A N/A DYE METHOD: Solution Dyed Solution Dyed TUFTED PILE HEIGHT: .156 .156 FINISHED BILE THICKNESS: .114 .123 STITCHES PER INCH: 7.3 8.0 GAUGE: 1/8 1/8 PRIMARY BACKING: Woven Polypropylene Woven Polypropylene SECONDARY BACKING: Polypropylene Polypropylene WIDTH: 12 Ft. 12 Ft. DENSITY: 8210 Ozs./Cubic Yard 8195 Ozs./Cubic Yard NBS SMOKE DENSITY CHAMBER FLAMING: Less than 450 Flaming Less than 450 Flaming ELECTROSTATIC PROPENSITY: Less than 3.5 KV Less than 3.5 KV WARRANTY: Ten Year Wear Warranty Ten Year Wear Warranty FHA: Type 1 & II A, Class 1 Type 1 & II A, Class 1 & 2 STYLE NAME: TUFTED YARN WEIGHT: CONSTRUCTION: FIBER: PROTECTIVE TREATMENT: DYE METHOD: TUFTED PILE HEIGHT: FINISHED PILE THICKNESS: STITCHES PER INCH: GAUGE: PRIMARY BACKING: SECONDARY BACKING: WIDTH: DENSITY: NBS SMOKE DENSITY CHAMBER FLAMING: ELECTROSTATIC PROPENSITY: WARRANTY: FHA: Viking 26 Stalok 26 Ounces Textured Loop 100% Solution Q B Florsept antimicrobial and S.S.P. Solution Dyed .156 .114 7.3 1/8 Woven Polypropylene Stalok 12 Ft. 8210 Qzs./Cubic Yard Less than 450 Flaming Less than 3.5 KV Teri Year W6ar Warranty Type 1 & II A, Class 1 Viking 28 Unitary 28 Ounces Textured Loop 100% Solution Q E, Florsept antimicrobial and S.S.P. Solution Dyed .156 .123 8:0 1/8 Woven Polypropylene Unitary 12 Ft. 8195 Ozs./Cubic Yard Less than 450 Flaming Less than 3.5 KV Ten Year Wear Warranty Type 1 & 11 A; Class 1 & 2 Product specifications are derived from averages, resulting from normal manufacturing toteranoes in yarn, fiber, temperature, humidity, and color, and may vary within normal industry tolemnees, Performance is not affected by such variances. As in all quality carpets, colors are subject to dye lot variations. Everest Partners 99 Rosewood Drive, Suite 270, Danvers, MA 01923 Telephone: 978.564.8002 1 Fax: 978.564.8003 Wednesday, May 18, 2005 Mike McGuire, Bldg Inspector Town of North Andover 27 Charles Street North Andover, MA 01845 RE: 800 Turnpike Street, N. Andover, MA Substitution of Licensed Construction Supervisor Dear Mike: John Petersen is currently the licensed professional (Construction Supervisor) on the NL Technology job going on at 800 Turnpike Street (Jefferson Office Park). John recently left our employ and Arthur P. Landry, II is the new Director of Construction and will be the licensed professional on the job. Attached please find a copy of Arthur's license, a copy of Everest Partners LLC's certificate of insurance evidencing worker's compensation and liability coverage. If you have any questions or concerns, please call me at 978-564-8002. Sincerely, Step en . McDonnell Regional Manager License: CONSTRUCTION SUPERVISOR Number: 'CS. 071654 Birthdate: 11/0'5/1;944 b Expires: '11105/2005 Tr. no: 8330.0 Restricted: 00 I Ij ARTHUR P LANDRY Il 6 MARGARET CIR j, NASHUA, NH 0306 Administrator From: Eileen P. Hart, AAI At: HUB International New England FaxID: 9789880038 To: Steve McDonnell Date: 5/18/2005 01:37 PM Page: 2 of 3 ACORD CERTIFICATE OF PRODUCER LIABILITY INSURANCE OP ID E DATE(MM/DDNYYY) EVERE-6 05/18/05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HUB International New England 299 Ballardvale St. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington Mh 01887 POLICY DATE EFFECTIVE !YY) Phone:978-657-5100 Fax:978-988-0038 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance CO. INSURER B: Fireman's Fund Ins. Co. Everest Partners LLC 99 Rosewood DrSte 270 Danvers MA 0193 A INSURER C: INSURER D: INSURER E: nw�e n we. 12/12/05 V. V Y G nj THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY DATE EFFECTIVE !YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX I OCCUR 1680-824OW172COF-04 12/12/04 12/12/05 PREMISES(Eaoccurence) $ 300000 MED EXP (Any one person) $ 5000 PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F7 JECT LOC PRODUCTS - COMP/OP AGG $2000000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $NY A AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WEC80929998 04/11/05 04/11/06 TORY LIMITS I I ER E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $500000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 50000 0 OTHER A Property Section Spec Form; RC 1680-824OW172COF-04 DED $500 12/12/04 12/12/05 Pers Prop $41,200 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS P`FRTICI!`ATC Ifni non *NOMORT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHO R _PRFs NTATIVE� ACORD 25 (2001/08) ©ACORD CORPORATION 1AAR 4 �nV Z Q 0. t Q V® V z 04 OSS z ui t/) Z `v LL. 0 Oz H 0 d � V RuinW C) w O A. ti W Ri It �;Eo -t' o �r 3; CH p c 40 4Q: C L- O :..m x0 CL Q E 0 _A _ �Ir n C ts rr m c E CL ` y m Ma C A m .33A ca ca � h �O p C aC� m ca w 'p d =. = p m p f m A y Z p cm m h CL= C Q : m cQ CD : p. p N I-- y m�� m uj _ ev= m N3 ui F— W mE .y o 0I:L COD V m per. C _ m aOy•a O N t ZZ a.=..m 9 joi I y CD h E co CL CD 0 CD CL CA O CL y C O cc C h r�-I a� ra c co 0 m m 3� vL CL CL cma � C O CD zC CLy C W Y/ Y/ W 0 /�uj w/� Y♦ 1A ILI v E IE � o g ° a°' U w W Ri It �;Eo -t' o �r 3; CH p c 40 4Q: C L- O :..m x0 CL Q E 0 _A _ �Ir n C ts rr m c E CL ` y m Ma C A m .33A ca ca � h �O p C aC� m ca w 'p d =. = p m p f m A y Z p cm m h CL= C Q : m cQ CD : p. p N I-- y m�� m uj _ ev= m N3 ui F— W mE .y o 0I:L COD V m per. C _ m aOy•a O N t ZZ a.=..m 9 joi I y CD h E co CL CD 0 CD CL CA O CL y C O cc C h r�-I a� ra c co 0 m m 3� vL CL CL cma � C O CD zC CLy C W Y/ Y/ W 0 /�uj w/� Y♦ y2679 Date.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. ���„ �c. _ • t .............. ......................................................... has permission to perform ` ....... f.�...<<................................................. wiring in the building of ............... lal.:j.7 ..:............................ s. �....... . , No .Andover M Fee ..,,! /: .. Lic. No. ✓ .� ... .. /..�4/ ....t/ ' ....... .............. .... .................... !� / ELE [CALNSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer I Office Use Onl��.,(, 0144 11amawnwe# of Massar4ustft,8 Permit No. �� i9epartment of Fubllt %fttg Occupancy & Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3i90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 10/24/2000 (M* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 800 Turnpike street suite #102 Owner or Tenant Kenrick Tny stmpnts Owner's Address 800 Turnxaike street suite -_#300 Is this permit in conjunction with a building permit: Yes ZI No ❑ (Check Appropriate Box) Purpose of Building Office Stti f.P4 Utility Authorization No. Existing Service 200.— Amps — I Volts Overhead ❑ Undgrnd ® No. of Meters —1— New Service Amps — I Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 800 Turnpike shrept miii-p #]02nff-jr-g Fit -up No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures rewire 15 I Swimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets 9 No. of Oil Burners a Battery Units No. of Switch Outlets 5 No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and I Total No. of, Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Devices KW /f No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: (2) Exits and one EM light INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ` NO _ I have submitted valid proof of same to the Office. YES = NO Z If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ` BOND —_ OTHER C (Please Specify) (Expiration Date) Estimated Value of Electrical ork S 2000-00 Work to Start Inspection Date Requested: Rough Signed under the Penalties of per �- FIRM NAME /� �2�/L / /G COU/4/ — Licensee ature Final LIC. NO. _ LIC. NO. w30 yt/1If% yG! /�- Bus. Tel. No. Address '9� /r G'� S��f� �7 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent l (Please check one) %/) -/._) ` / Telephone No. PERMIT FEES l (/ (f - !%/ VVV (Signature of Owner or Agent) x-6565 w i ON Date..�-.c�.j...n..- :- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that./�. v •w:� has permission to perform ...... - T ?- � _i ' �, .0/. �.. _......✓ wiring in the budding of �� �`-� ................................................................................... at .. .../G4 -� �J 2- �` .................... , North Andover, Mass. - C1f1............. ...................... / / .L_.... ........... Fee :� ............. Lic. No .............. .. i/c_ .r............ � :.... / -ELECTRICALINSPECTOR Check # ��� ZUZ/�� C Commonwealth of Massachusetts Official >Use Only Department of Fire Services Permit No. ©; Occupancy and Fee Checked 3s BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE;t4�rL I1VFfJTION) Date: City or Town of: fir By this application the undersigned gi s notice of his or Location (Street & Number) U U0 tl n To the Inspector of Wires: To perform the electrical work described below. S-7- Owner % Owner or Tenant 4n Telephone No. Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Yes ❑ No (Check Appropriate Box) 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: Installation of Security system Cmmnletinn nftha fnllnud— tnhla ... , h,, ..,..;—.1 A-. LU 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. 2rnd. 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 o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: NumberTons 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 KW SecurityNof Devices or Equivalent No. o Water Kms, Heaters No. of No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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) pv Estimated Value of Ele rical Work: c,-2—��, (When required by municipal policy.) (Expiration Date) Work to Start: a 54 -Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME:ADT Mv-WniijeLIC. NO.: 15.3.1' Licensee: John S. Bassett Signature J LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: • OWNER'S INSURANCE WAIVER: I am aware that the Lic, see 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: $ Cry Location No. -zj� Date Q CL NORTH TOWN OF NORTH ANDOVER3 ptt��•° �•1�0 i? .• • o� o A Certificate of Occupancy $ * > Building/Frame Permit Fee $ �'+s C e� s�cHus Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ T Water Connection Fee $ TOTAL $ ao Building Inspector *, Tn SM Div. Public Works PERJIIT NO. `�� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. L.00ATION 800 Turnpike Street suite 105 PURPOSE OF BUILDING office suites OWNER'S NAME Merdith and. Grew NO. OF STORIES SIZE OWNER'S ADDRESS 160 Fedrail Street Boston, MA, BASEMENT OR SLAB slab ARCHITECT'S NAME N/A SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME Pelham Construction SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION office fit -up IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER yes IS BUILDING CONNECTED TO NATURAL GAS LINE no INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 6/12/95 DIGNATURE OF OWNER ORAUTHORIZED AGENT \, - F E E PERMIT GRANTEDDj� �1 uC l 190 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 5875.00 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY 0 L) MUILDINQ OWNER TEL. # ( 617) 330 8139 CONTR. TEL. # ( 603) 635 8651 CONTR. LIC. # 058659 H.I.C. # 110155 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S ORIES MULTI. FAMILY OFFICES _X APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 13 PINE CONCRETE CONCRETE BIL K. BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL ql ab '/, 1/1 1/1 N_O B M T HEAD ROOM FIN. B'M'T' AREA FIN. ATTIC AREA FIRE PLACES MODERN KITCHEN _ _ _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH B 1 2 —{I_ _ J_ 3 DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME _ 11 ATTIC STRS. &FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I-1 POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13BATH 13 FIX) GAMBRELMANSARD A TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. X HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 10 13rd I ELECTRIC NO HEATING I THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6 e ON rA ct x w A d aG Q w v V) y a cin cd 0 t r_4 z z ,..., A w a o w° 7 wo' v G U w 94 O t z z w O LO w a OE. w � U W w ao' cn w a COOv d ao' w z w w w w G , co' ° z cn A o cn ui W W W. Z, CIS : w 0 C V I: O ` CJ C O a� CLc co ea m c = o rar,, Ea Vi 4D C mk. c a. 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FORM U - IAT RELEASE FORM ` INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** ot& o*,e tG, APPLICANT: SeTTers�i b4A, P!2L,,-L-XP Phone 1"I `1$3-603'1 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street -Tw-N h��-2 St. Number '00 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections / - driveway permit Z1 Fire Department` Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date KOV 1 91993 Location D 4 ���ii.w�`e, a o No. � Date lei NpRTN TOWN OF NORTH ANDOVER Certificate of Occupancy $ y B,itjding/Frame Permit Fee $ r U t� Foundation'Permit Fee $ f Other Permit Fee $ J�-1-1 !ta/ _° 65 1 1 wgrr Connection Fee $ 19 %ater Rnnection Fee $ TOTAL } $ J y • Building Inspector Div. Public Works PERMIT,VO._ v APPLICATION FOR, 'PERMIT XO BUILD — NORTH ANDOVER, MASS. l�Ja/�n/���,� jjPAGE 1 MAP d40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZQNE SUB DIV. LOT NO.(o G - I LOCATION A �, t!` ,tq\ `��.. � � as URPOSE OF BUILDING a��� ;�����• OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS `� ,�.� BASEMENT OR SLAB ARCHITECT'S NAMEhQ�� \1*� SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR , " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION oFkx.e �.1= ,U�, IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES 9 PAGE 1 FILL OUT SECTIONS 1 - 3 4 AGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLIyNS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR ---" ^ice,,... — J.^ It,G'i 04 FEE 9 , '19 (-o . PERMIT GR D 'R TEL. # 60 X30o 3 P 19 CONTR. TEL. # J IanMEN .illy 0 PROPERTY INFORMATION COST EST. BLDG. C093FOr ,2' l��v EST. BLDG. COST PER $O. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN , id BUILDINQ INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 OOS: SINGLE FAMILY sroulEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6-�% C t F !T U �- B'M'T 2nd _ ELECTRIC fi t 1st 13rd NO HEATING 1_' 1Y CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE d 2 13 CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL V, 1/2 �/� FIN. B M T' AREA FIN. ATTIC AREA _ _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ EARTH HARDW D COMf�ACN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY BRICK ON FRAME ATTIC STRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) TOILET RM. (2 FIX.) WATER CLOSET _ _ GAMBREL FLAT MANSARD SHED ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS i NO. OF ROOMS GAS OI L C SINGLE FAMILY sroulEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 6-�% C t F !T U �- B'M'T 2nd _ ELECTRIC fi t 1st 13rd NO HEATING 1_' 1Y Semaphore Training 800 Turnpike Street, Suite 200 North Andover, MA 01845 685-6236. - _f r Thank you for your cooperation. Very truly yours, Karen T. Leal, Sec'etary Hamilton Realty Cpany Proposal No, PELHAM CONSTRUCTION CORPORATION sheet No, 1 of 2 790 Turnpike Street d/b/a Balcom Road Construction Date 2/26/93 North Andover, MA 01845 Proposal Submitted To Name__._John Horan/Hamilton Realty Co. Street1_�T`unnl e ree City North An over State MA _ Telephone Number Work To Be Performed At Street (Semaphore) 800 Turnpike Street City Nor n over Date of Plans Architect We hereby propose to furnish all the materials and perform all the labor necessary for the completion of e co e of work as follows on page 2 All material is guaranteed to be as specified, and the above work to be performed and specifications submitted for above work 'pnd completed in o substantiolworkimanlikerdmanner ytfor ttthe dsum'hgs of *******Twenty -Two Thousand Nine Hundred Fifty and N0/100** Dollars ($22r950.00** with Payments to be made as follows; Any alterotion or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become on extra charge over and above the estimate, All ogreements contingent upon strikes, accidents or delays beyond our control, Owner to carry Are, tornado and other necessary insurance upon above work, Workmen's Compensation and Public Liability Insurance on above work to be taken out by Respectfully submitted Dwight Brown Per ' Note -- This proposal may be withdrawn by us if not accepted within days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and ore hereby accepted, You are authorized to do the work as specified, Payment will be made as outlined above. Accepted Signature Date Signature I Proposal Page 2 of 2 Semaphore Training 800 Turnpike Street North Andover, MA Sub -division of tenant's space for new hallway and tenant build -out: 1. Demolition: Walls and carpeting $ 900 2. Sprinkler Work $ 1,000 3. Ceilings: new 2x2 heavy textured ceiling in hallway. Also includes ceiling repair to both sides of tenants space. $ 1,600 4. Paining of tenant's space two (2) coats, latex flat. Includes oil base paint for doors, frames and windows. $ 2,000 S. New Walls: 1/2"' drywall to underside of ceiling - 160'. $ 4,800 6. New walls to be demising walls to underside of decking with 5/8" fire shield - 112'. $ 4,260 7. Doors: seven (7) 3' 0" x 6' 8" solid core doors in wood frames with 2 1/2" colonial casing, paint grade - includes hardware. $ 1,400 8. Doors: five (5) 3' 0" x TO" solid core birch in steel knock down frames - includes hardware. $ 1,900 9. One (1) glass insert for existing door. $ 200 10. Electrical: all outlets, lighting and switches necessary - includes fire alarm work in hallway. *New 2x2 light fixture in hallway and exhaust fan in tenant's office. $ 2,800 11. H.V.A.C: allowance of $800 $ 800 12. Carpet: patching of carpet in tenant space due to moving hallway wall - approximately 8" x 45'. $ 450 13. Baseboard: new vinyl base all new walls - 800'. $ 840 Total.... $22,950 OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING Town of 120 Main Street pooks NORTH ANDOVER North Andover. r� .;•... �, Massachusetts O 1845 DIVISION OF (617) 685.4775 - PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of.Facility) tgnature of Pcrmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: H hyr-�tzrd U 'P,t-0, �-1 Phone LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street +kSt. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department 'M C• Received, by Building Inspect 11 EUILDING DEPARTi iiAENT Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 219 Date Jiji.Y 219 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 800 TURNPIKE STREET - Suite 200 MAY BE OCCUPIED AS Office fit -up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. �MvrtrN , CERTIFICATE ISSUED TO Hamilton RPaI t)z °4L Briton Ave. 010�Z - I ADDRESS Rnqtnn. MA 1�sACHU '!ding Inspector C7 O Z cn m D O z T z r 3 CA 'v C d CD 'v O 0 z .y iD O `/• r � � c d N! O n v CD CD CL .r* CD CCD O CSD C CD ya Qv y O COD � v Cn O � z CD o CD 0 CD n I I4-1 cm- V F -a cn 0 O z 0 W O to O C CL co to K O CO) CL0 0_ z .. y W N y Q Hma� 3 = CCDL -4 O CD m N O O .+ W : m = O O N: to � O : C7 O.wO O ...f O G y n � O O S y O = a: - CD CD �oCD' CL CD N CA fy y =: C a ID• N o_. W CD o to N y� :� O CD �CD s I CD o 3.imI CO)CD k A CDSz a CO CA co �. ate•: 5 CD c o a G OaGi� O fD O n r O G O O w G G Q. a O d O n a (D�y 0 0 O c ? 0 rf, ? x 0 0 0 c Location 7Z4 4 ile STs U, le No. -v Date f c 7 HORTh TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ lJ * Building/Frame Permit Fee $ �� S SS CH' Mus E � Foundation Permit Fee $ � s�t Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ CVS Building Inspector T $ 02/18/97 09:15 12.50 MID Div. Public Works PER'%IIT NO. —% APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER, MASS. J PAGE 1 MAPh_1O. oA� `l LOT NO. I 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE SUB DIV. LOT NO. �I LOCATION c6a) —uin��l;c cam- C� ���# Qt1 J C PURPOSE OF BUILDING ` li OWNER'S NAME .Me��` a 6-Ae��,` 1 Y` K NO. OF STORIES -3 SIZE OWNER'S ADDRESS 5� BASEMENT OR SLAB 5 �� ARCHITECT'S NAME W; I kO,WLS(3N SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME pe kf_ a -w\ ` SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION `c ti O•V\� h i•T u, IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER •`,� 7�•l BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER e S IS BUILDING CONNECTED TO NATURAL GAS LINE NO INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEDAND APPROVED BY BUILDING INSPECTOR 1 DATE FILED A / 5 � cl D SIGNATURE OF OWNER OR AAUTHORIZED AGENT ~ FEE PERMIT GRANTED 1>i /069' CA, (l0 0 I 3 PROPERTY INFORMATION I LAND COST I EST. BLDG. COST) EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY �UILDINO INSPECTOR OWNER TEL. +4 CONTR. TEL. N 663 6 3 5% 6 S l CONTR. LIC. # b 9"iro 5 H.I.C. # 1 o 1 5 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION E3 INTERIOR FINISH 3 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE HARDW'D _ PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL 1/1 1/2 l/. FIN. B'M'T' AREA FIN. ATTIC AREA _ _ N_O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS CONCRETE EARTH B 1 —2 XI 3 _X _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARMU'D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR_j_ WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP if BATH (3 FIX.( GAMBREL] MANSARD TOILET RM. 12 FIX.( FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. w B'M'T 2nd _ ELECTRIC 1st 3"d2d I NO HEATING K1 ` F' xU w A co '\o w° C/) a cin � z z W G w ao a°' v U w O z a t w U W U w W w chi w cx O a z o a w W W w C co z cn Q co W a1 O O o 0 ' m c ;c o Z o a O D h � C C V c c "0 y �O O C., C.) .ECDw m m ■. Cl. � - = v. c C� co :mom O � :L o � O p m Ea ca o C ea ea 'a c C z s _ts Y ts O d Ul C c Y N �Ec ' o m -. c CO2 (N, cm v a= Go Cc � CD o m a cm y : co m z:= 0 ce N Cc C ao CM �•_= o o> �dC � m p � m � ytONo L • O c o U U C> 4c ao cm c_ i : N �L 3 mYp = � m a N0 VD ea L m � .Y W C o ���„ CyL.. •� N dt •C p Y Z O ujm fl EmN� 0�-�a 5 CD ��a o o F- L $a. -m W a1 O O O 0 o � Z o a O D h � C C y "0 y �O O .ECDw m m ■. Cl. � - = *-+ co O � y � O oa ca o C ea ea 'a c C z s c O d Ul C c c CO2 J Ct� c Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the building permit and or request for plan review for the property indicated on the reverse side: i IG �i lei 1141 Health vrEEP��L�"M .13 , ,E; ai R �^ ^ n t'I l� i.7,��,9�'S�ti}. ��2 8% 'aI b�r!318{s3 it lot 3A Y n 5�i'7yu ue3 Conservation Department of Public Works Historic Commission � I•= rc� to w,LL Other 3 . � vim= �i✓`�t�iuY► Cs� �'� bra Ur�, c ro &>p-i/zeb Rpfprral racnmmended Fire Health Police Zoning Board Conservation Department of Public Works Historic Commission Planning Other Other Town Of Forth Andover Building Department 508-688-9545 'J `3 Plan o - �, Review 146 Main fit. Tovvn Fi II Annex — suite � b pr���� f►�E2.� t� � APPLICANT: DATE: 6Q, x`79 7 Zoning District . qui =�. �- Use Code,: � Title of Plans and Documents: e, P. A F 0�r.�-7%vYi op rl,4 R io%fir z, Request: Gc t'L 1,06- I'�lzvk ch Ing- ar=rrr�,&' &"V ✓*rh�" Please be advised that after review of your building permit and or zoning review has been DENIED for the following reasons: Zoning Use not allowed in District Not in conformance with Phased Development Violation of Hei ht Limitations Sign exceeds requirements Violation of Setback Front Side Rear Insufficient Lot Area Insufficient Parking Violation Contiguous Building Area Insufficient Op en Space Insufficient Lot Frontage Sign requires permits prior to Building Permit Ij Form U not complete by other departments Not in conformance with Growth By -Law Use requires permits prior to Building Permit Other Other Remedy for the above is checked below. Dimensional Sign Variance Special Permit for Watershed Review Special Permit for Site Plan Review Special Permit for sign Complete Form U sign -offs Copy of Recorded Variance Information indicating Non -conforming status Copy of Recorded Special Permit Variance for Sin Other Plan Review The plans and documentation submitted have the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. Foundation Plan Plumbing Plans Subsurface investigation Certified Plot Plan with proposed structure 5 Construction Plans t 127 Affidavit N&rk-b5 f�oTi4,� -Mechanical Plans and or details Tr -&4 Plans Stamped by proper discipline Electrical Plans and or details I Framing Plan Fire Sprinkler and Alarm Plan Roofing Footing Plan Plans to scale Utilities Site Plan Water Supply Sewage Disposal Waste Disposal Other ADA and or AAB requirements Other Administration The documentation submitted has the following inadequacies: 1. Information Is not provided, 2. Requires additional information, 3. Information requires more clarification, 4. Information is incorrect. 5. All of the above. The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and or request for plan review to receive approval. 119 Building Department Official Signature Information Received e_ If Faxed : v Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. Water Fee State Builders License Sewer Fee Workman's Compensation Building Permit Fee Homeowners Improvement Registration Building Permit Application Homeowners Exemption Form Other Other The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice, by the Building Department, shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new building permit application form and or request for plan review to receive approval. 119 Building Department Official Signature Information Received e_ If Faxed : v Denial Sent If you require assistance please call the above number and we will be able to guide toward meeting the necessary requirements. Please understand that many of the reason for denial are related to the code requirements that must be met to ensure public safety. Requirements for detailed plans are necessary to ensure that there is enough information through plans and specifications to show that code requirements will be met. t3t)i.i,i)1146 11 'YOWN OP NUItTIA ANDOVER CUNSTRUCTIUN CUNTROL PROJECT I)UIillER1 'IUJECI` TITLEtCS 'PROJECT LOCATION: Turnpike street Nor, , . n over, . f ,, hAIIE OF IIUILDINGs Jefferson office park NATURE OF 11110JECT t office fit -up TI IN ACCURDANCE WITH SECTION 127.0 OF THE HASSACIIUSETTS- STATE BUILDING CODE, 6LU Registration No. II -EMG A REGISTERED PROFESSIONAL ENGINEER/ARCHITECT HEREBY CERTIFY TIIAT 1, HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, C011PUTATIONS AND SPECIFICA-TIONS CONCERNING: I• , ENTIRE PRUJECT A ARCHITECTURAL STRUCTURAL M HECIIAHICAL (_1 FIRE PROTECTION d ELECTRICAL 01IIER (specify)LD FOR THE ABOVE NAMED PROJECT AND THAT, 10-TIIE BEST OF IlY KNOWLEDGE, SUCH PLANS, 011PUTATI.ONS AND SPECIFICATIONS MEET THE'APPLICABLE PRUViSIUNS OF TIIE HASSACHUSET•1S 5'1'ATEBU1LU111G CUllE9 ALL ACCEPTABLE ENGINEERING PRACTICES.' '! APPLICABLE LAWS AND ORDINANCES FOR 111E PROPOSED USE A11D OCCUPANCY. 'I`FURI•IIER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE ". PRESENT ON THE CONSTRUCTION SITE Oil A REGULAR AND PERIODIC BASIS TO UETEI1111HE 11IAT •NINE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING f;R:11T AIM SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN ,SECTION 127.2.2: 1. Review of shop drawings, amples and other subndttals of the contractor as required by the cmistruction contract docutmnts as submitted for building permit, and approval for cmiformmtce ' to the design concept. I „.! 2. Review and approval of the quality control procedures for all code—required controlled materiels. 3. Special architectural or engineering prof essimml.inspection of critical construction cuil)ottents requiring controlled materials or construction specified in the accepted engbiceritlg practice standards listed in Appendix B. PURSUANT TO SECTION 127.2.39 I SIIALL SUBHIT WEEALY A PROGRESS REPORT TUCEIHER �I1T11 PERTINENT COMMITS TO THE NOR•1'11 ANDOVI;Ii IiUlLU1NG 1.NSPE"C'1.0II. ''UFUN COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT S TO TI 5A1'ISF "lOItY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. Ss iw,A'lU1tE S-06SCRIBED A11D SWU ti 1 Qj 1)'Q/ 1, Tills DAY OF 19 .IIUTARY PUULIC FE S . '► 11-A MY C011111SSION EXPIRES C©0 FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. *****************Applicant fills out this section***************** l APPLICANT: N e_,� ` x 6, t Q\ -' Phone (01--) LOCATION: Assessor's Map Number O Parcel Subdivision -Lot(s) O O SO Street�SOa \"`' '^ 1J1 ��� S \ Sc `��Ze2 St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire. Department i /rL c<<O; CVh L% /6J 1-Z) G'4cc/ Received by Building Inspector Date JQW ARCHITECTURE 12 FARNSWORTH ST. BOSTON MA 02210 (817)350-3035 FAX 350-7803 Fixture Schedule Partition Schedule EXISTING PARTITION TO BE REMOVED 120 V DUPLEX @ 18" AFF, NEW PARTIONS (VATCH EXISTING) , TELEPHONE ❑UTLET,SINGLE GANG 18 -AFF, EXISTING PARTITIONS TO REMAIN PROJECT O FFI C E RENOVATION floor 2 Jefferson 8OO CLIENT RESEARCH ENGINEERS Office Park 0 5 scale 10 DATE 1/23/1997 REV. .0s l-eiung r ix -Lure �cneciu(e NOTEi RELOCATE EXISTING 2x4 FLOURESCENT LIGHT LIGHT FIXTURES AND MATCH EXISTING DIFFUSERS SUPPLY NEW ONES F NEEDED G.C. TO VERIFY ALL ® RETURN AIR SPRINKLER HEADS LOCATIONS + AND PROVIDE NEW IF NEEDED AS CODE REQUIRES O SUPPLY AIR JQW ARCH[TECTURE 12 FARNSWOM ST. BOSTON MA 02210 (817)350-3035 FAX 350-7803 PROJECT OFFICE CLIENT RESEARCH DATE 1/23/1997 RENOVATION floor 2 ENGINEERS A-2 Jefferson Office Park (-I n n n T-) T rN ry REV. General Notes & Specif icatlons 1. ALL LABOR AND MATERIALS SHALL CONFORM TO STANDARD TRADE PRACTICE,MANUFACTORS REC❑MMENDATIONS,FEDERAL,STATE AND LOCAL BUILDING CODE REQUIREMENTS. 2. UNLESS OTHERWISE NOTED,ALL MATERIALS AND METHODS OF INSTALLATION SHALL MATCH EXISTING BUILDING STANDARDS. 3, BUILDING CLASSIFICATIONS, A. USE GROUP ------B (BUSINESS) B, CONSTRUCTION TYPE-- 2C 4. MODIFY ANY EXISTING FIRE SUPPRESSION AUTOMATIC FIRE DETECTION,MANUAL FIRE PROTECTIVE SIGNALING SYSTEM AND OTHER FIRE PROTECTION SYSTEM AS REQUIRED TO FACILITATE NEW LAYOUT AS PER CODE REQUIREMENTS,LANDL❑RD SPECIFICATIONS AND LOCAL FIRE DEPARTMENT REGULATIONS. 5. ANY WOOD FRAMING -AND/OR BLOCKING SHALL BE FIRE RETARDANT TREATED, 6. LANDLORD SHALL,PRIOR TO DEMOLITION, HAVE THE AFFECTED AREAS OF THE FACILITY INSPECTED FOR THE PRESENCE OF ASBESTOS AS PER EPA REGULATI❑NS. 7, ALL NEW FLOOR PENETRATIONS FOR MECH. EQUIP,ELECTRICAL EQUIP. AND OTHER OPENINGS SHALL RECEIVE REQUIRED FIRESTOPPING AS PER CODE REGULATIONS AND MANUF. SPECIFICATIONS. 8. WALLS THAT SEPERATE ADJOINING TENANTS SHALL BE 1 HR, FIRE RATED WALLS (FLOOR TO DECK). 9. REUSE EXISTING ELEC./CEILING IF NEAR PROPOSED NEW LOCATION. CONFIRM WITH OWNERS REP. TO CONFIRM 10. ANY REFERENCE TO ELECTRICAL OUTLETS LOCATIONS PLUMBING,HEATING,VENTILATING,OR AIR CONDITIONING, FIRE PROTECTION INFORMATION IS FOR AESTHETIC AND C❑❑DINATI❑N PURPOSES ❑NLY,AND NO ATTEMPT HAS BEEN MADE TO PROVIDE ENGINEERING SERVICES AREA OF CONSTRUCTION RESK e v Plan ENGINEERS JQW ARCHITECTURE 12 FARNSWORTH 5T. BOSTON MA 02210 (817)350-3035 FAX 350-7603 PROJECT OFFICE RENOVATION floor 2 Jefferson 800-10 NOTE, G.C. TO REPORT ANY OMMISSI❑N OR DISCREPANCIES TO ARCHITECT VERIFY ALL DIMENSIONS IN THE FEILD REMOVE ANY EQUIPMENT AND NON USED CONDUIT,ELEC, OR PIPING IN AREA'S OF CONSTRUCTION USE BLANK COVER PLATES FOR NON USED RECEPTACLES ALL TELEPHONE AND DATA LOCATIONS WILL BE DETERMINED AT A LATER DATE BY TENENT PAINT NEW CONSTRUCTION AREA'S ONE COAT OF PRIMER TWO COATS OF FINISH PAINT COLOR TO BE SELECTED BY TENANT AT LATER DATE PATCH AND REPAIR ANY HOLES IN CONSTRUCTION AREA'S Door Schedule NO. TYPE FRAME HDWR,SET REMARKS OI STAND, MTL, STAND. 0 STA D. MTL. STAND, OOSTAND . MTL. STAND. 4 5 . . D.MTL. MTL. © STAND. MTL, STAND. BLDGO7 STAND. MTL. STAND, 8 STAND, MTL. STAND. g BLDG, STAND.10 MTL, BLDG. BLDG, MTL, BLDG. ll STAND, MTL, STA D, 12 STAND. MTL. STANBLDGD. °"ENT RESEARCH ENGINEERS Office Park DATE 1/23/1997 A-3 REV. CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number �;—o Date THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS 6PP! C -F, IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. I -Itz i CERTIFICATE ISSUED TO LW - I ADDRESS // .; r-- 1 w rA �lLLJ O z CL a �a 0 y a lz z o t co- f O 0 O CD CD z CD C. c� O p y C o � �cm c N �ECD0 m m °w a CD ~ = Z �3 cc CLc O O O O ev � d ca ca ID c O +_-+ c . C. O,�'� o End " env c c c. m o .y 0.- in E.E m .0 c *_.. O O •' cn m :C c E CDL.. 0 O � H = C43ca �3 = y �. E o mo s CO av OC ~� 0 cm CM" C CLCOS m .R Z o CO ..- CLO cm Q = o m c a m e c H r0. :ago N N m W O Ow~ AS U- y O Q06 W E O= C w.fl�y Z o � C.3� m o v F. CL �� S =tea-wmZIP f O 0 O CD z CD C. O p y C I �cm �ECD0 m m a CD ~ = Z �3 cc O O O O cc M: d ca ca O +_-+ c . C. O,�'� o C. " env c c c. .y April 1997 To: JQW Architecture North Andover Building Department 146 Main Street North Andover,MA 01845 Subject: Completion of Office Renovation at 800-2 bldg. Jefferson Office Park (Floor 2) Research Engineers Suite North Andover,MA I John Q.Williamson Architect ( Mass. licence no. 7476 ) verify observation and completion of Office Renovation at 800 Jefferson Office Park. Work completed by (Pelham Construction ). Sincerely John Q.Williamson,Architect • JQW Architecture / 12 Farnsworth Street, Boston MA. 02210 / (617) 350-3035 PELHAM CONSTRUCTION 38 Balcom Rd. Pelham, N.H. 03076 Date: 4/23/97 T0: Building Department North Andover,MA. I Dwight A Brown, of 38 Balcom rd. Pelham, N.H. D/B/A Pelham Construction was the construction supervisor, License #058659 at 800 Turnpike street North Andover for permit # 50 Tenant being Research Engineers and the owner being Meredith & Grew hereby certify that renovation was constructed under my observation and to the Massachusetts Building code. 0 ---- ---------- Dwight A. Brown r Location No. Date J 106'08 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 6�-v Building/Frame Permit Fee $ �� m Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ r, Water Connection Fee $ A TOTAL _ $ %L 3 � v `'Building Inspector Div. Public Works N PE nirr Nb._60 0�- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 Y 16 MAP M -4O.0) D LOT NO. 6Q sQ 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE SUB DIV. LOT NO.I — I LOCATION '-e ilVo PURPOSE OF BUILDING F Ic cS F i 7` OWNER'S NAME m e,C %IN, x 6 rCw NO. OF STORIES 3 SIZE OWNER'S ADDRESS /bV 7p_ _ ev- \ Sl- ��Q y` BASEMENT OR SLAB c+LPIi� ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME, SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IeBUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS C F CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER V IS BUILDING CONNECTED TO NATURAL GAS LINE �6 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING DATE FILED 12 / r g Inc SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E Z PERMIT GRANTED /:z A� 19 JAN 2 7 1997 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST ' 2 , O6o EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. JI _61-) 3-36<6-%4H CONTR.TEL.# 603 635<86S, CONTR. LIC. # H.I.C. # S I OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETEp�Jl a 1 2 CONCRETE Bl'K. I PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ 7t UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA 1/1 1/7 1/1 FIN. ATTIC AREA N_O B M'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 _ DROP SIDING CONCRETE X WOOD SHINGLES EARTH _ _ _ ASPHALT SIDING HARDVJ D _ ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRI K N MAS NRY ATTIC STIRS. b FLOOR BRICK ON FRAME iC WIRING 5 ROOF I 10 PLUMBING GABLE HIP BATH 3 MANSARD I�I TOILET 12 FIX.) 6 FRAMING 11 HEATING WOOD JOIST t PIPELESS FURNACE r r FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. & COLS. A HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS 01-� 1st 3rd NO HEATING I I BUILDING RECORD v t C r r 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. J C f 0 FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary j approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: mty %�� t,(, 6r e k -J Phone 60 7 33 a 'i LOCATION: Assessor's Map Number 6 ``lz Parcel Subdivision Lots) GAO S6 Street (:�GU ���a�hg S_"� �O® St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner _.Date Rejected Comments Food Inspector -Health Septic Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Comments ahi �-7 M7 Public Works - sewer/water connections - drivewav permit Fire Department Received by Building Inspector 11 Date AA J QW ARCHITECTURE 12 FARNSWORTH ST. BOSTON MA 02210 ® ® ®o® (617)350-3035 EXISTING EXISTING EXISTING e.�m�_ FAX 350-7603 lim EXISTING EXISTING WwAl EXISTING II)I NEW OFFICE NORTH AREA PLAN ff0 0 NOTE, RELOCATE EXISTING LIGHT FIXTURES AND DIFFUSERS SUPPLY NEW ONES IF NEEDED G.C. TO VERIFY ALL SPRINKLER HEADS LOCATIONS AND PROVIDE NEW IF NEEDED AS CODE REQUIRES CUE" SEMAPHORE PROJECT OFFICE RENOVATION FLOOR 2 0 5 scale 10 DATE 9/23/1996 A-2 ® REV. 10/7/1996 EXISTING REV. 10/21/1996 Ceiling JEFFERSON OFFICE 41 Of PARK 800-2 ® ANDOVER MA CUE" SEMAPHORE PROJECT OFFICE RENOVATION FLOOR 2 0 5 scale 10 DATE 9/23/1996 A-2 ® REV. 10/7/1996 EXISTING REV. 10/21/1996 Ceiling Fixture Schedule LIGHT MATCHH EXISTING MATCH EXISTING RETURN AIR ® SUPPLY AIR SUPPLY NEW LIGHT FIXTURE, NEW DIFFUSERS(SUPPLYAND RETURN) AND SPRINKLER HEAD IN NEW OFFICE AREA PATCH CEILING AND FLOOR TO MATCH EXISTING EXISTING II II 0 II ��fM IINEW OFFICE NEW jFICE u II ® II SP REMOVE EXISTING WINDOW TRANSOMS AND STORE WITH LANDLORD SUPPLY NEW S RINKLER HEAT IN EXISTING CORRIDOR TO COMPLY WITH BUILDING CODE SOUTH AREA PLAN JQW ARCHITECTURE 12 FARNSWORTH ST. BOSTON MA 02210 (617)350-3035 FAX 350-7603 JEFFERSON OFFICE PARK 800-2 ANDOVER MA CIIENT R-1-81 SEMAPHORE EXISTING PROJECT OFFICE RENOVATION ---oSP FLOOR 2 0 5 scale 10 DATE 9/23/1996 A-3 REV. 10/7/1996 REV. 10/21/1996 tit OF NO. TYPE FRAME HDWR,SET NOTEi OMATCH EXIST' General Notes & Specifications J Q W THESE NOTES ALSO APPLY T❑ THE ARCHITECTURE (SOUTH AREA ON DRAWING A-2) 1. ALL LABOR AND MATERIALS SHALL CONFORM (IF POSSIBLE) G.C. TO REPORT ANY OMMISSI❑N TO STANDARD TRADE PRACTICE,MANUFACTORS 12 FARNSWORTH ST. OR DISCREPANCIES TO ARCHITECT VERIFY ALL DIMENSI❑NS IN THE FEILD RECOMMENDATIONS,FEDERAL,STATE AND LOCAL BOSTON MA 02210 BUILDING CODE REQUIREMENTS. (617)350-3035 REMOVE ANY EQUIPMENT O MATCH AND NON USED MATCH EXIST'G FAX 350-7603 C❑NDUIT,ELEC, 2. UNLESS OTHERWISE N❑TED,ALL MATERIALS OR PIPING IN AREA'S AND METHODS OF INSTALLATION SHALL 4MTL, MAUCH OF CONSTRUCTION MATCH EXISTING BUILDING STANDARDS. USE BLANK COVER PLATES 3, BUILDING CLASSIFICATIONS, A, USE GROUP ------ JEFFERSON FOR NON USED RECEPTACLES B (BUSINESS) tC�`�gE C�¢F f OFFICE ROOM 112 RECIEVES NEW CARPET B. CONSTRUCTION TYPE-- 2C TO MATCH EXISTING/ALL OTHER AREA'S 4. MODIFY ANY EXISTING FIRE SUPPRESSION PARK OF CONSTRUCTION USE THE REMNANTS AUTOMATIC FIRE DETECTIORMANUAL FIRE FROM DEMO AREA'S PROTECTIVE SIGNALING SYSTEM AND OTHER 800-2 ALL TELEPHONE AND DATA FIRE PROTECTION SYSTEM AS REQUIRED TO L❑CATIONS WILL BE DETERMINED FACILITATE NEW LAYOUT AS PER CODE REQUIREMENTS,LANDLORD SPECIFICATIONS ANDOVER AT A LATER DATE BY TENENT AND LOCAL FIRE DEPARTMENT REGULATIONS. MA PAINT NEW CONSTRUCTION AREA'S ONE COAT OF PRIMER 5. ANY WOOD FRAMING AND/OR BLOCKING TWO COATS OF FINISH PAINT SHALL BE FIRE RETARDANT TREATED. COLOR TO BE SELECTED BY TENANT 6. LANDLORD SHALL,PRI❑R TO DEM❑LITI❑N, °LZN7 AT LATER DATE HAVE THE AFFECTED AREAS OF THE PATCH AND REPAIR ANY HOLES IN CONSTRUCTION AREA'S FACILITY INSPECTED FOR THE PRESENCE OF SEMAPHORE ASBESTOS AS PER EPA REGULATIONS. VCT TILE FLOOR IN NEW KITCHEN 7. ALL NEW FLOOR PENETRATIONS FOR MECH, EQUIP,ELECTRICAL EQUIP, AND OTHER WILL BE TO MANUF,SPEC'S MATCH EXIST FLOORS OPENINGS SHALL RECEIVE REQUIRED PROJECT COLOR TO BE SELECTED BY TENANT FIREST❑PPING AS PER CODE REGULATIONS AND MANUF. SPECIFICATIONS. OFFICE AT LATER DATE 8. WALLS TO EXTEND ONE FOOT ABOVE EXISTG RENOVATION REMOVE ALL BULLETIN BOARDS AND WALL CEILING,WITH 3' INSULATION, ABOVE CEIL'G FLOOR 2 FIXTURES NEEDED BY TENANT AND RELOCATE 3' BATT INSULATION. AT THE DIRECTION OF THE TENANT. 9. REUSE EXISTING ELEC./CEILING IF NEAR PROPOSED NEW LOCATION, CONFIRM WITH RELOCATE EXISTING OWNERS REP. TO CONFIRM 0i 1�0 KITCHEN EQUIPMENT i SC ale SINK,CABINETS AND SODA MACHINE/COFFEE 10, ANY REFERENCE TO ELECTRICAL OUTLETS LOCATIONS RELOCATE PAY TELEPHONE PLUM BING, HEATING, VENTILAT ING,OR AIR CONDITIONING, DATE 923/1996 FIRE PROTECTION INFORMATION IS FOR AESTHETIC AND COODINATION PURPOSES ONLY,AND NO ATTEMPT HAS BEEN MADE TO PROVIDE ENGINEERING SERVICES, A-4 `'`r z 7 REV. 10/7/1996 REV, 10/21/1996 Key Plan NORTB AREA PLAN Door Schedule NO. TYPE FRAME HDWR,SET REMARKS OMATCH EXIST' MTL. MATCH EXIST'G REUSE EXISTING (IF POSSIBLE) O MATCH MTL, MATCH EX[ST'G REUSE EXISTING (IF POSSIBLE) O MATCH MTL. MATCH EXIST'G REUSE EXISTING EXIST' (IF POSSIBLE) 4MTL, MAUCH MATCH EXIST'G R ING OMATCH EXIST' MTL. MATCH EXIST' ZA tC�`�gE C�¢F f Bu Partition Schedule Fixture S ======= EXISTING PARTITION TO BE REMOVED I VA y� �glly �pS� NEW PARTIONS (MATCH EXISTING) 120 V DUPLEX @ 18' AFF. Of EXISTING PARTITIONS TO REMAIN TELEPHONE OUTLET,SINGLE GANG 18 -AFF, U2'i PROJECT HUHBER1 OFFIC.E OF BUILDING 1 NSPEC OR 'FOWN C11-- NOR'.f1.1 ANDOVER CONSTRUCTION CONTROL •'IUJECT TITLES �l��� ;, 1 FR" OJECT LOCATION: OW-�„ Turnpike street NortF,-A�n over, . '-, NAME OF BUILDING: Jefferson office park NATURE OF PROJECT: office fit -up IN ACCORDANCE,WITH SECTION 12760 OF THE MASSACHUSETTS STATE BUILDING CODE, 1 It ® A � ��� 1a��?44d60 Registration No. �L "•' BEING A REGISTERED PROFESSIONAL ENGINEER/ARCIIITECT HEREBY CERTIFY THAT 1.IIAVE PREPARED .-.-OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AIJU SPECIFICA— TIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL d STRUCTURAL 1-1 MECIIANICAL I_—] FIRE PROTECTION Q ELECTRICAL M, O111ER (specify)LD FOR THE ABOVE NAMED PROJECT AND THAT, TO•TIIE BEST OF MY KNOWLEDGE, SUCII PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE'APPLICABLE PROVISIONS OF THE MASSACHUSETTS SPATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES.' '! APPLICABLE LAWS AND ORDINANCES FOR T11E PROPOSED USE AND OCCUPANCY. "'-'I`FURTIIER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE 1 I• PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AILD PERIODIC BASIS 1'0 DETE1I11111E 111AT .TIIE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING ';I'F;RMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED Ili ,SECTION 127.2.2: . 1. Review of shop drawings, samples and othuer submittals of the contractor as required by due cmnstruction contract documents as suhnitted for buildinug permit, and approval onuci ce to the design concept. F 2. Review and approval of the quality control procedures for all code-requir materials. 3. Special architectural or engineering profess irnna1.inspect ion of criticalk 'ou n1 requiring cmntrolled materials or construction specified in tine accepted pr stmxiards listed in Appendix B. FPURSUANT TO SECTION 121.2.3, I SHALL SUBMIT WIIKLY , A PROGRESS ETHER �JIT.H PERTINENT COMMENTS TO THE NOR'1.11 ANDOVER BU1LD.ING 1.NS1'EC1.UR. UPOIJ COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL RQ= AS TO THE SATS AC10RY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPAIIUd , _. 'i•.. S IGNA1 UItE SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 19 1101A1tY PUBLIC MY COMMISSION EXPIRES (X m T-4 T.; a E CD O E CD ■ O V z CD C. O CO) p C CO2 CD 'ff m m CD 0 CD cc NO CD �3 wO cccY O Q CL � �a Co S o �NO ccC _v ■CL O 4-0 C Z W O C.3 y O C C CL _h 0, 0 me c �S O C N O c c O ca C.i CL cc C O W �k :Z O E a CF s m o _ ts �., m :4.a E c m t; os :c E C-- ca C N c;- y h CD3 O N C - ._ �. m ' 0 Co CA N O E D _Q Tv mo aw L: o N m M c s C� O c 4=0 •_ MA � CCH) Z ev o cow �o cp c _ 400 30 H CL W w C fA m r0+ ~ n = m w �NJ m c ti �E O •" V = IS •N� 2:W p " a 0.0 ca i�� s o CLOW a E CD O E CD ■ O V z CD C. O CO) p C CO2 CD 'ff m m CD 0 CD cc NO CD �3 wO cccY O Q CL � �a Co S o �NO ccC _v ■CL O 4-0 C Z W O C.3 y O C C CL _h PELHAM CONSTRUCTION 38 Balcom Rd. Pelham, N.H. 03076 Date 1/22/97 To; Building Department North Andover, Ma. I, Dwight A. Brown, of 38 Balcom Rd. Pelham, N.H. D/B/A Pelham Construction was the construction supervisor, license # 058659 at 800 Turnpike St. North Andover, Ma. for permit # 626 Tenant being Semiphore Training, suite # 200 and owner being Merith & Grew hereby certify that renovation was constructed under my observation and to the Massachusetts State Building code. - - -------------- -- ------- Dwight A. Brown Z Z CF) V— z z > 4) > 0 cis 1<24 rA LLJ V) rA 0 z LL 0 o k -D rA '00 ON w z C'41 z 0 E C q rA FL z E 0 z a c cc CD w I' 6 IN January 1997 To: JQW Architecture North Andover Building Department 146 Main Street North Andover,MA 01845 Subject: Completion of Office Renovation at 790 Jefferson Office Park (Floor 3) Semiphore Suite /North Andover,MA I John Q.Williamson Architect ( Mass. licence no. 7476 ) verify observation and completion of Office Renovation at 790 Jefferson Office Park. Work completed by (Pelham Construction). 5incerel / l /John. Q.Williamson,Architect 14 JQW Architecture / 12 Farnsworth Street, Bostdn. MA. 02210 / (617) 350-3035 4 Location I Gf R tJ P No. y Date C TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL PC/ Building Inspector Div. Public Works w a i �I W O z 0 F p 8 k z Z a Y °o �p t vit O Z — m Of 0 m 9 U f X (n a, W W a ►- WW L u Q 0 z W > Z 7 0 O _ W W W N Io N 9 U �' C d lz 0. a 0 m 5 Ci v� a a tWp z 0 � :) Z r1 vt m W m W U m LU d i IN U 1 OC W W 3vi 3 o o W ^ N 0 0 o Z o < IK W hIK S 0 0 m Wm SF 0 i ~ Z W J LL 0 0 m O W 0 J IL U p W m N N g LL 0 f W LL o W = N d z m N m < N 03 M VI d fL W H t � L d V) s �v, 3 3 0 p aU1ZL/6�L a aZo��- 010 31 100 tpW ` �v W < W O Z N f Z Q Z O Z N < N F W N K r QZ W < U OJ W z W z ,' u O J N 0 0 < m M WI9-61 A Fo m m N W _J YI O mgr LL O IA z O N w : O < W C r 0 j LL 0 W C 0 z F 00 LL LL O W N m A T I N W O z 0 F p 8 k z Z a Ln �p t vit Z — v Of 0 m 9 U f X (n a, W W a ►- WW L u d 8 0 z W > � 7 0 o; W W m a' a U F 9 9 U �' C d lz 0. a 0 0 us Ci J j 3 z 0 tWp z 0 � :) Z r1 u m z F J W m W m W U m LU F i U U 7 3 o o W O N w m r 0 j LL 0 W C 0 z F 00 LL LL O W N m A T I N o w W J LL W f < O W O k V- W Ln m t 4 Of 0 N W 0 (n O F � � 7 0 M O LL Z z 0 0 us Ci u z Z m N 0 0 LU F i U U 7 3 o o W O N w m e < hIK p 0 0 m J J i 0 J_ J = k LL U p W 0 - N IK L m WW V M VI d fL W < o w W J LL W f < O V- 00 Ln Of Vo (n � 4 0 J JUA us Ci cr LU 3 o o O U V = o w W J LL W f < O N 00 00 M Zm y0 yZZ D (A ; O k 1 D Z I' N G fAO* O mx H Z D Ana T ;aZ_ a 'a 0 O N T O _ N Z m cn_N v r r90 N _ . ITT Z -Z 11 so Z m O O C D In mm mm OnruDiypio�DAm 0� D3 D . mn m D A D M n; Z ti m p� m p D c ~ n D O A x 00A T O f OA Z m3;:; = Nva =Z p Dp£ j Q A A -1 T ID/1 N C A n IT IO m 7.7. A 0 0 v c Z �m0xy�mN Z Z n n n^ n�� x 0 v A p D W vnZ N y_10 CI O'y mm 00000 IOONOy�N0 A3: C Omti mT A x N Z Z A Z Z O O O N N 2 A O� A m m T Z D D D Z Z x n T; Z Z z a Z Z a 3 a w O N; 3 m HGl O DtDi�O>nDDT'yOZZ�O D m Zn <t mm;= O mo AZ N oG1N ; N D v T Z A m Z N Z O 0 {� { { Z n 1 I I I i I I I IIII I I I I i I I I_KIJ_LL__ 1111 �I N Z x 'y ➢ N D D n x n ; T m r c pox v A O + D> O D o c N O D D O 0 O A Z Z r A D O n< D ti m V -/ A A A Z m m ( N A Z co C T O 1 r vmypyx O_p f1 =y o=m Av Dm Z `m� m mm Z SCZOn 4J DO A rZ0 -� ZY-�� DAO Z NN n O w3N< r; T m A N m m x m n ti •r 0 CC O. X v N m m Z 7C m N C I n A 11� v D A X O CELL 0 Z (- Z 8 A J�1I I�11LKj �I m JLIUJ Iti IIIIIiI I I IIIII�I� IIII I�IIiI" �� D 0'I N M Zm y0 yZZ SOC M k 1 D fl 0 0 fAO* mim mx H Z D im n moo ;aZ_ MOE T C nwo�mm m cn_N v r r90 Z Day m Z -Z A so 0 0Ni 7O v m> 0 Z In mm mm 0� D3 . W FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: a E' r"TV V, r lz� U-) Phone 61 33 6 �6 LOCATION: Assessor's Map Number Parcel 00 5 0 Subdivision © ?��`CE f �' U �� Lot (s) Street X6 V ur i\pk fCe s Sbu OC -76' a St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections Date Approved Date Rejected Date Approved Date Rejected driveway permit Fire Department /0 Received by Building Inspector Date aa�C.0, PROJECT NUMBER: PROJECr TITLE: .',PROJECT LOCATION: NAME OF BUILDING: . !NATURE OF PROJECT, OFFICE O1' BUILDING 1NSPEC'FOR TOWN UC NOR'.f1.1 ANDOVER CONSTRUCTION CONTROL r... Turnpike street Nortn,7ndover, Jefferson office park office fit—up IN ACCORDANCE WITH SECTION 127:0 OF THE HASSACHUSETTS STATE BUILDING CODE, 1UjAN,1A 16 Registration No. _74-76, 6, _ BEING A REGISTERED PROFESSIONAL ENGINEER/ARCIIITECT HEREBY CERTIFY THAT I,IUVE PREPARED '.-OR DIRECTLY SUPERVISED TIIE PREPARATION OF ALL DESIGN PLAITS, CUMPUTATIONS AND SPECIFICA—TIONS CONCERNING: ENTIRE PROJECT(' ARCHITECTURAL Q STRUCTURAL U MECHANICAL [--I 'r FIRE PROTECTION Q ELECTRICAL 01-11ER (specify)CD FOR THE ABOVE NAMED PROJECT AND THAT, TO•TIIE BEST OF MY KNOWLEDGE, SUCH PLANS ,'1*1PUTATIONS AND SPECIFICATIONS MEET THE'APPLICABLE PROVISIONS OF THE ; STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES.' :40 APPLICABLE LAWS AND ORDINANCES FOR TIIE PROPOSED USE AND OCCUPAN( !'I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SER }'RESENT ON' THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO D '.'•THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN .SECTION 127.2.2: I. Review of shop drawings samples and otliet subrrdttals of the contractor as required by die construction contract docunents as submitted for buildi:►g permit, and approval for cmdomence to the design concept. 2. Review and approval of the quality control procedures for all code—required controlled materials. 3. Special architectural or engineering profess imna1.inspect ion of critical construction tarpmirents requiring controlled materials or construction: specified in the accepted engirieeririg practice standards listed in Appendix B. . ' ,PURSUANT TO SECTION .127.2.3r I SHALL SUBHIT WEEKLY A PROGRESS REPORT TOGETHER 0#11 PERTINENT COMMENTS TO THE NUK'1'11 ANDOVER BU1LD1N(; INSPECTOR. OR. r, COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT A5 TO THE SATISFACI'OItY COMPLETION AND READINE �� ��n������� \\�Q1� �F5 P b4�CT FOR . OCCUPAN &,_ O ° << ��' �\ •�jpiSSr N • � �9 S 1 9 GNA1 URE SUI3SCRI B S DAY 0F 0 uew 19 ,NOTrY: PUBLIC// lrii//// ''�O ..••CHu ..•'�C� \�'; HY COMMISSION' EXPIRES 119`Z7" PUS` cb y f LJ �® V O 1p b L== _____ N © C /Z\ qp 0 lal Lo 91 N qH N cn W 0 o D tia w Z� w � � o 0 m► Z .T 90 z G1 'pal A� �tl mm m �~ �m zrl- cD) N� 0A t D 1+1 m 58 to PROJECT OFFICE, ct.�rrc DYNAMIC 0 o to RESOLUTIONS �Cv 44 c FLOOR 1 INCi w w x� I oo Jeff erson Office Park -1 o o 800-1 BLDG. ANDOVER MA W o 4 � p Mme_ m 4� t� ►b y * � d " o N O GO n N O o N +, w+ w X3 N tiro n � o y � pn ryes ti PROJECT OFFICE DYNAMIC RES❑LUTI❑NS �0 or C-1 RENOVATION FLOOR 1 INC, 00,150 o Jefferson Office Park C\D 800-1 BLDG, ANDOVER MAW 0 o • x c � m z ® . n M A ♦ w Z w � m o "" A N z m �z £ r c -9 f Y U -U�'� A d < o tl X Cf Zo a m x a'i c IO n N m O m o '" r �o N N 'A Q .`[� (7 S rr ti czi D '1 N Q �M rI wm `�J E3 D N r C !C z 0 1 m F+ 02 a 71 1 D ®W0000 00000 { N IO -I `�' 12 -; m :3 m x x x x x x x x 3 R 'l O A rrrrrrrrrri;o 0 m _, a = 2o xX <+ 9 A I Qg �S} ['2 (� Qg 42 a', m � N y in y y y y y it �o n A Q � N N DD V 0� N A Si N �+ C) DAA wf7 aT1pmD D -Ix N <Am •MD zAA£!r ODDD 2Z ZCC rl mcr W>> D z DA -1 ZmamrAC3 COC'lA 0, o -a- W Dw C Sac D2z tdAia Cm pr ►r Im wrr m ,, r� -4 rO Nmm c om�A�arqX � z m� my p m H Z x -iIF�N iGGZlrm -4 mtlx CMN,G V'..mty and 1 z;aa pZCp '4 Z<G `� �m� Cxm N�xAr ranlzilaN �m rmrq-4-�0a m�mmmm� 0 c or xxo Nd= oDAA Z L1 ,�. D Z A m 1<z rw1 A rf7o A-qD AA a m a %m maraA Ammr ma .Torg-lN..m Ar rr-;ux A CD .1. AN -om z A C„1„tj mp Z c�Z+ y O A 000 Ozd +�jA.ArA A�i*1�� MZ Ut,rZDbi Z I � eo�N mya3 � y A z�m ?CD f�0,00Z mOdCA Dp >AOrl Crm o -Or-<N<«r.1Z Nzm Ll 'I 1 n -< a ► Zm r C_Im*lma-I tl 90 w ►ir 3 .I. ►mr'rn rZ Del .Aa n ;2f7 �m r10<-07;0 pAA tyZ S m [3 E3 a AAri mi Z\ DZo Adc1-i'1 L1 f7 x �ZNNimi I m W- 1 bap zrm m Am AA 3D DD N D A z m Or z0 ym'AZU Z`ir CSyo 1A C3 MpM., ZA2. ODfjq ♦Zm ^D Ci td N Zyifr/1 N 0 x i o Q zz 1 Amdz rm t7 1 aD mag0 D mZ in 013 A maC N - Cl z 11" NHD Dor iirr Ulan19 = n y) A �'' m m ►mrp mrtl f0 ;� OG Cp2'I �A...IC Dm vim �nZIA'1;C� CDC7CZrm y bZ3 D=i mx n Q 1 m m< DC"'A ZWrq A3 OZma Gz �m DOd-emtmil vl CrA aZr ei z Z Ll G �m M xm mm p m 0 cZ .irZm C�A� or Cin nz 7 < r� N = "' Cli D 2mz H oA r N o1A v1 C -q L1 DAA r 0 x m m PROJECT OFFICE'`' DYNAMIC o N RENOVATION RESOLUTIONS 4 � � m FLOOR 1 INC. w w 01 x oo Jefferson Office Park � w 0 800-1 BLDG. ANDOVER MA W 0 o x c � m z m x =� A A w Z w � m o "" A N z m �z 1 M Li x 1 0 e• CERTIFICATE F... 1 :moi OCCUPANCY Town of North Andover - Building Permit Number c{/ -;-;>- Date /t 2 A THIS CERTIFIES THAT THE BUILDING LOCATED ON ©c� MAY BE OCCUPIED AS f C-49 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS ut PELHAM CONSTRUCTION 38 Balcom Rd. Pelham, N.H. 03076 To: Building Department North Andover, Ma. I, Dwight A. Brown, of 38 Balcom Rd. Pelham, N.H. D/B/A Pelham Construction was the construction supervisor, license # 058659 at 800 Turnpike St. North Andover, Ma. for permit # 412. Tenant being Dynamic Resolutions, suite # 100 and owner being Merith & Grew hereby certify that rehovation"was constructed under my observation and to the Masschusetts State Building code . ---------------- Dwight A. Brown August 1996 To: JQW Architecture North Andover Building Department 146 Main Street North Andover,MA 01845 Subject: Completion of Office Renovation at 800-1 bldg. Jefferson Office Park (Floor 1) Dynamic Resolution Suite North Andover,MA I John Q.Williamson Architect ( Mass. licence no. 7476 ) verify observation and completion of Office Renovation at 800 Jefferson Office Park. Work completed by (Pelham Construction). Sincerely 00Z John Q.Williamson,Architect ```��aunrr►r��� p,EL S. TF���iii �•` � yissioti�•. �� �� o i i 2 9SSgCHUsF O •. RY JQW Architecture / 12 Farnsworth Street , Boston MA. 022,1'qlg (61 7) 350-3035 .. `.....•�..��......�� /.j v/vlf vf1M Mr rL1V&A/1%Jtr rown iCneasi su NV 1"Lul�lu�lw --� (Print or TvDel I� NORTH ANDOVER, .Mast. Oatsn--r .1V- Lo"cau � gam' mer'. Name New O Renovation Replacement ❑ FIXTURES 3t r - Plana Submitted: Yes O No. O Check one: Installing Company Name C - AS A (,-Ai E_ L= t`r_ O C. Address 4 (R 7- O Partnership C-->0` "'&tS4O Firm/Co. Buslness Telephone -'Ko -5'- 5 .5'. 7-M I Name of Ucensed Plumber INSURANCE COVERAGE: ec one I have a current liability Insurance policy or Its substantial equivalent. Yes O No O II you have checked yU, please Indicate the type coverage by checking the approprlate box .. A liability Insurance policy M-/ • Other type of Indemnity O Bond O Certificate OWNER'S INSURANCE WAIVER: 1 am aware that the Ilcensee does not have the Insurance coverage required by Chapter 112 of the Masa. General Lews, and that my signature on this permit application waives this requirement. Check one: Signature of Owner a Owns s Agent Owner O Agent O I hereby certify that al of the details and Information I have submitted forentered) b above application are bw and accurate to the best of my krwvrledpe and that alp1umbinq work and Installations performed under the Permit Issued for this application will be In compliance with all pertinent provisions of Chi Massachusetts Stale Plumbing Code and Cuspis 1420l -071Lowe. BY ,-A Title na urs of Lkensed Plumber Cltyfrown IIF' ITWED (OFFICE USE ONLY) License Number �c9, 7 "7 TYPe of Plumbing License: Master Journeyman 0 NNEMENN Check one: Installing Company Name C - AS A (,-Ai E_ L= t`r_ O C. Address 4 (R 7- O Partnership C-->0` "'&tS4O Firm/Co. Buslness Telephone -'Ko -5'- 5 .5'. 7-M I Name of Ucensed Plumber INSURANCE COVERAGE: ec one I have a current liability Insurance policy or Its substantial equivalent. Yes O No O II you have checked yU, please Indicate the type coverage by checking the approprlate box .. A liability Insurance policy M-/ • Other type of Indemnity O Bond O Certificate OWNER'S INSURANCE WAIVER: 1 am aware that the Ilcensee does not have the Insurance coverage required by Chapter 112 of the Masa. General Lews, and that my signature on this permit application waives this requirement. Check one: Signature of Owner a Owns s Agent Owner O Agent O I hereby certify that al of the details and Information I have submitted forentered) b above application are bw and accurate to the best of my krwvrledpe and that alp1umbinq work and Installations performed under the Permit Issued for this application will be In compliance with all pertinent provisions of Chi Massachusetts Stale Plumbing Code and Cuspis 1420l -071Lowe. BY ,-A Title na urs of Lkensed Plumber Cltyfrown IIF' ITWED (OFFICE USE ONLY) License Number �c9, 7 "7 TYPe of Plumbing License: Master Journeyman 0 Ir F' = 32JL 6 Date ...- 3--? � TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING °SACMUSE� . This certifies that ... -,..... has permission to perform ... plumbing i t e �b/uildings of .. . ,�f„l. _ .ri���,r,....... at ...J . � L/'` �.? .�<' '} . • • . • K • A, th Andover, Mass. Fee.� ..... Lic. No . ............................. . /JE -�) �—'q (-/ PLUMBING INSPECTOR 01/29/97 10:37 75.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer .--••�-�--. �.. vrvr�vnrvt /�r'rua.r�asusv r%jn irrnwss su {J%./ rL:/rvlr.�u�u -� (Print a Typal NORTH ANDOVER, Maga. Oats Iii f7 b �— Building G 1 u r ti Perma *• 3 316 ,�� Location _ 1 S� 2 Owner's \� - Name I�t"(i sc �� (= v c.v t� V v�" New Qi Renovation ❑ Replacement ❑ Pians Submitted: Yes ❑ No J� FIXTURE$ ".._. _.". Installing Company Business Telephone <o k' M, ((Rio f Name of licensed Plumber C & c1121 , k ; rll , Check one: ❑ Corp. ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: Check one 1 have a current Ilablity Insurance policy or Its substantial equivalent. Yes ❑ No ❑ If you have checked y". please Indicate the type coverage by checking the appropriate box A Ilabilly Insurance policy Other type of indemnify ❑ Bond ❑ Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does rad 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: Slanatuts of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby csrtian ly that al of the details d Information I have submitted W sntsredl in above appficalion ars bus and accurate to the best of my knowisd�• and that al plumbing work and Installations performed under the PQmA laswd for this application will be in complance with all pertinen provisions of the Massachusetts State Plumbing Code erd Chapter 112 of UM Law". Title CitylTown APPIKMD (OFFICE USE ONLY) Ucense Number 1 bG 7 7 Type of Plumbing License: Master ®� Journeyman 0 w s11 < N 0 ` = L s O 1' t r O a ori w t! » w s = o L o a I- U> o Y a �� s a$ s o u w 1 1 r�i M w Sao o sue—�fYT. •AatMtNT 1ST PLOON IN0'LOOR 11110 FL0011 4TH FLOOR ITH FLOOR ITH FLOOR. ITHPLOOt GTHPLOO11 Installing Company Business Telephone <o k' M, ((Rio f Name of licensed Plumber C & c1121 , k ; rll , Check one: ❑ Corp. ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: Check one 1 have a current Ilablity Insurance policy or Its substantial equivalent. Yes ❑ No ❑ If you have checked y". please Indicate the type coverage by checking the appropriate box A Ilabilly Insurance policy Other type of indemnify ❑ Bond ❑ Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does rad 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: Slanatuts of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby csrtian ly that al of the details d Information I have submitted W sntsredl in above appficalion ars bus and accurate to the best of my knowisd�• and that al plumbing work and Installations performed under the PQmA laswd for this application will be in complance with all pertinen provisions of the Massachusetts State Plumbing Code erd Chapter 112 of UM Law". Title CitylTown APPIKMD (OFFICE USE ONLY) Ucense Number 1 bG 7 7 Type of Plumbing License: Master ®� Journeyman 0 r - - — - Date .�`' ?. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform . .................... plumbing in the buildings of l .":9:. . at .�U!i ! Ll2tarli c , r� ...................S...<.<. a � :�.. ,North Andover, Mass. Fee. 3. .. Lic. No. /O. G. .? .............................. PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A_ �p O ED 014r Tommauwr# . of Mtto.a#uuttg Bevartment of Puhlir 1_96afetq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only � r Permit No.41-9 Occupancy & Fee Checked /00 3/90 (leave blank) olw APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 1 /-7(()-? (M* 7 ()-?(M* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) lgoQ e- Z'\ re. SU 1T 2p0 Owner or Tenant Sey�AP� �C0.h�h� 0 Owner's Address 160 recS.e � S`� ,osteo V fAA Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) �Z Purpose of Building © (F So I'- , _ Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 6 FICC 1 \ U,�) OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO = 1 have submitted valid proof of same to the Office. YES = NO _. If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE BOND = OTHER —� (Please Specify) D Estimated Value of Electrical Work St V�' 00 Work to Start Inspection Date Requested Signed under the Penalties of FIRM NAME Licensee ,�i4 iQ? e— Signature Rough (Expiration ate) Final LIC. NO. Zd y1� 811t LIC. NO. L Bus. Tel. No. % G�%—� �� Address % T1 C1v S/tic /��<-y` �^ �W /Q'�� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owryar/ Agent l (Please check one)* /' U Telephone No. PERMIT FEE S V (Signature of Owner or Agent) x•6565 Total No. of Lighting Outlets I No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimmin Pool Above g grnd. 7L_ In- grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets �� I No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ran Ranges 9 No. of Air Cond. I tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Local Municipal❑ Other ❑ Connection No. of Dryers 1 Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO = 1 have submitted valid proof of same to the Office. YES = NO _. If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE BOND = OTHER —� (Please Specify) D Estimated Value of Electrical Work St V�' 00 Work to Start Inspection Date Requested Signed under the Penalties of FIRM NAME Licensee ,�i4 iQ? e— Signature Rough (Expiration ate) Final LIC. NO. Zd y1� 811t LIC. NO. L Bus. Tel. No. % G�%—� �� Address % T1 C1v S/tic /��<-y` �^ �W /Q'�� Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owryar/ Agent l (Please check one)* /' U Telephone No. PERMIT FEE S V (Signature of Owner or Agent) x•6565 1\ Office Use Only _ Ir LfUM 1jUWr# Uf .'J]lb,a55alr4U9ett9 Permit No. +Bepartment of Public 3ufetq Occupancy & Fee Checked _ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date—2—5 , q� (X* or Town of NORTH ANDOV .R To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) .8 ,00 IQT K p\Vc SL) li E_ 2� Owner or Tenant 1<P�hC� �`' �-�`� 'NQe, Owner's Address /66 Fe LO, stTr Is this permit in conjunction with a building permit: YesX No ❑ (Check Appropriate Box) Purpose of Building C7 r,�Q \ce .SCJ S Utility Authorization No. Existing Service aOO Amps New Service Amps Volts Overhead ❑ Undgrnd R .Volts Overhead ❑ Undgrnd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �L r /T ' 2z i OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 7 NO = 1 have submitted valid proof of same to the Office. YES = NO _. If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ,= BOND ^-- OTHER (Please Specify) u GG (Expiration Date) Estimated Value of Electrical Work S �• / a �-'` Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury. `%// !, FIRM NAME �P��� v , /"/ !" LCD UR /— LIC. NO. -?2 yZ (9�E Licensee Signature' iL ' -/ LIC. NO. ,t Bus. Tel No. //�� Address t� � /I/ �� � r Rel- ` /�! lt/ � / , 0 6W7 � Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial quivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Or Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) � /x•6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above grnd. [I In- E- grnd. Generators KVA — No. of Emergency Lighting No. of Receptacle Outlets 2,0 No. of Oil Burners Battery Units No. of Switch Outlets /6 I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Local E] Other 1:1Connection I No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP L - I i OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 7 NO = 1 have submitted valid proof of same to the Office. YES = NO _. If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ,= BOND ^-- OTHER (Please Specify) u GG (Expiration Date) Estimated Value of Electrical Work S �• / a �-'` Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury. `%// !, FIRM NAME �P��� v , /"/ !" LCD UR /— LIC. NO. -?2 yZ (9�E Licensee Signature' iL ' -/ LIC. NO. ,t Bus. Tel No. //�� Address t� � /I/ �� � r Rel- ` /�! lt/ � / , 0 6W7 � Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial quivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Or Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) � /x•6565 . T2 739 Gf NOR7FI "o TO O s Date .... n WN OF NORTH ANDOVER PERMIT FOR WIRING SACllus .. a This certifies that ................ ,..11.....x: F........... has permission to perform ..1-1.44-4-6 G ...tf..... t ......................... wiring in the building of ......�......-'Y! ..,........................... at ....; North Andover, Mass. FeeTv�.. LIc. No32� ........................................................... ELECTRICAL INSPECTOR C 'r �O 02/18/97 49:15 75.04 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 0J 4t CfUmmnUwe# Uf ffittUg#e S� � i3epartment of Public 3$ttfetg BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Off i e se Only VV� Permit No. Occupancy & Fee Checked 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (%* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below,�.�j /�l Location (Street & Number) �SOd Vrh tJl 1-� A�Jr�� /1G0c.)f-r- Owner or Tenant Owner's Addressy S Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building D70�4--rc S�igC C- Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -i- i 74- ///7 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 7 NO = I have submitted val d proof of same to the Office. YES '_ NO If you have checked YES, please indicate the type of coverage by checking the app priate box. INSURANCE BOND OTHERD Z (Please Specify) E D Estimated Value of Electrical Work S a 4 u C-) Work to Start 9=A/ Inspection Date Requested: Rough Signed under the Penalties of perjury; a' // 6. , FIRM NAME `/ " e, G v U� Licensee or Siiggnature [ Addresssn , —' /G / d ( xptration ate) Final LIC. NO. �o=dF IC. NO. s Vis. Tel. No. 417 Alt. Tel. No. Ir OWNER'S INSURANCE WAIV : I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) M Telephone No. PERMIT FEE S _ _6b (Signature of Owner or Agent) x•5565 \(- 4 ��� Total No. of Lighting Outlets � I No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above grnd. ❑ In- grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets V No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges 9 No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Dishwashers I Space/Area Heating KW Detection/Sounding Devices Municipal Local ❑ Connection []Other I No. of Dryers I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 7 NO = I have submitted val d proof of same to the Office. YES '_ NO If you have checked YES, please indicate the type of coverage by checking the app priate box. INSURANCE BOND OTHERD Z (Please Specify) E D Estimated Value of Electrical Work S a 4 u C-) Work to Start 9=A/ Inspection Date Requested: Rough Signed under the Penalties of perjury; a' // 6. , FIRM NAME `/ " e, G v U� Licensee or Siiggnature [ Addresssn , —' /G / d ( xptration ate) Final LIC. NO. �o=dF IC. NO. s Vis. Tel. No. 417 Alt. Tel. No. Ir OWNER'S INSURANCE WAIV : I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) M Telephone No. PERMIT FEE S _ _6b (Signature of Owner or Agent) x•5565 \(- 4 ��� 423 Date ........ W2f.... ( TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... �. �..-ki .......... vq .L. ocASLE ................... has permission to perform ....... .M�N..CAA ........ � ... ................. wiring in the building of ......... .................... at ...... . 0 .0 ........ ....................... , North Andover, Mass. Fee... /A� ........ Lic. No.IaA4.r ........................................................ ELEcrmcAL lNspEcm �— k b49/4/14 11:28 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer T' .... ' �_, .� .. �^ n . � ....- -,.. _ � ._ .. _ _. tip._.. ,.,« ..+� .. •" ti, �_ _ ,__ .,,. L Date ........:....... i �- 678 TOWN OF NORTH ANDOVER PERMIT FOR WIRING y� This certifies that ............!...�-C�: ............. has permission to perform .... ... .<.C/........,�� ( .:. /l. ...... wiring in the building of . at ..........1...? 4 .............. . North Andover, Mass. 1 t Fee. ZOO- ........ Lic. No...:.'J. 1 -,).C ........................................................ ELECTRICA LINSPECTOR C4 1G6o 41/09/9 1:j 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 36%6 2 Date ...` ......�............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................. ............. ,.�..�..�:................... � ....... � 1.................. has permission to perform i I Ji wiring in the building of .................... I.. ...................... at .......:...� t?.. "'"--u fir': _North Andover, Mass. Fee .... r ... Lic. No. `.... . ._.�.. . ..................... / ELECTRICAL I spECTOR Check # Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use On 111 Permit No. �` Occupancy and Fee Checked /,f-0 ev. 11/"] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 3-25-02 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) 800 Ar nd Floor Suite 202 Owner or Tenant iviemsrc %,urp + Telephone No. Owner's Addrem same Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of B■ilding Office Space 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: Remodel space Com letton o the olle ing table mm be wamdhv the /ns ctor o Wires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Existing Swimming Pool Abovd.e ❑ rod. ❑ ry ng gaffeNO. of Units No. of Receptacle Outlets 15 No. of Oil Burners FIRE ALARMS N& of Zones No. of Switches 4 No. of Cas Burners o.07 MtMlon as Initiating Devices No. of Ranges No. of Air Cond. Toon No. of Alerting Devices No. of Waste Disposers at Pump Totals: _. Number .......__. ons _.___._._........__.__. o. o outs Detection/Alertinz Devices No. of Dishwashers Space/Area Hating KW Local ❑ unrc ❑ Other Connection No. of Dryers Hating Appliances KW SecuritySystems: Na ofDevices or Equivalent No. o sten KW Heaters o. o o. o S• Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Teletiommunications WirlAg: No. of Devices or uivaient 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:) Estimated Value of Electrical Work: $1,000.00 (Expiration Date) (When required by municipal policy.) Work to Start: 3-25-02 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cerft ander the pains and penalties ofpedwy, that she iirformadon on this o"Hea lon fa late and cotnpld&- FIRM NAME: A. S. Jones & Co., Inc. LIC. NO.: A10430 Licensee: Albert S. Jones Signature LIC. NO.: 15648 E pfapplicahle, enter "exempt„ in the license number line.) Bus. Tel. No.- 508-42971300 Address: PO Box 6758, Holliston, MA 01746 Alt, TeL No.; 508.429-2807 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) nowner owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ,.. Office Use Only - 01 4c Tnmmunu>r# of 14finsur4usefto Permit No. 233 — __ department of Public —Aafetq Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 s/so (leave blank) APPLICATION FOR. PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (X* or Town of NORTH ANDOVER To the Insector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) /FV(J Tw A9 At /I/ / -c Owner or Tenant �%r .e e �/�i 6"X Owner's Address Is this permit in conjunction with a building permit: Yes 1G No ❑ (Check Appropriate Box) A ff1.? VI/ Purpose of Building Existing Service Amps —J Volts New Service Amps _J Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No Overhead LJ Undgrnd ❑ Overhead ❑ Undgrnd El No. of Meters No. of Meters OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = NO = I have submitted valid proof of same to the Office. YES = NO - If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work SUC Work to Start >�GO Inspection Date Requested: Rough A3 S Final Signed under the Penalties of per FIRM NAME ���� `/Ne 0 LIC. NO. 3 d y61031E' Licensee S/� L Signature �- ? c� = �� LIC. NO. �/" /�/,�� Bus. Tel. No. SO 7 y'S /9 r? Address `! ��u �` S� ���� '" `� Alt. Z. No.. SOf75;IS'' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ,...�. Telephone No. PERMIT FEE S�� (Signature of Owner or Agent) x•6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above^ grnd. L_ In- r- grnd. J Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No'. of Ranges No. of Air Cond. tons Initiating Devices Heat Total Total No. of Disposals No.of Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal 71 Other � Connection No. of Dryers ry I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES = NO = I have submitted valid proof of same to the Office. YES = NO - If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work SUC Work to Start >�GO Inspection Date Requested: Rough A3 S Final Signed under the Penalties of per FIRM NAME ���� `/Ne 0 LIC. NO. 3 d y61031E' Licensee S/� L Signature �- ? c� = �� LIC. NO. �/" /�/,�� Bus. Tel. No. SO 7 y'S /9 r? Address `! ��u �` S� ���� '" `� Alt. Z. No.. SOf75;IS'' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ,...�. Telephone No. PERMIT FEE S�� (Signature of Owner or Agent) x•6565 Date ... 5 !.....).....9. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....,:....... ... 4?UR...,. c` has permission to perform ....0 } ` ...... 1 .1 t. . ............. wiring in the building of ... ...z:.:t: J. ........ .........•....... c icc�at � ................. L:!'... P , !f ........ E..................... , North Andover, Mass. g Fee...... Ltc. No.. ,�:........ ....--...................................................... � ELECTRICAL INSPECTOR �+ �1zz z. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File N2 46`3 Date 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... J ...� �.t......................... has permission to perform .. !.? 4.`^ `':..`. .. S .... i plumbing in the buildings of , .1 , V qvi -) at ..l�G�.. !r�'.��.`',/'. `* .. �!............ . North Andover, Mass. Fee. .0 .. Lic. No.. P ... (. ... ....... PLUMBING INSPECTOR Check # / � v( WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location ti v suite #102 Building permit #5 Owners Name Date It Permit # Amount Type of Occupancy Office suites New Renovation Replacement Plans Submitted Yes � No Aomnirn ovi cf-i nri ci nlr and r•An _ (Print or type) Installing Company Name Address E. J. Plumi Check o Certificate Corp. •i Partner. Firm/Co. Name of.Licensed Plumber- Insurance lumberInsurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Cry Other type of indemnity 11 Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above F three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa�>settpState PlumbingCo"�Chapter.142 of the e General Laws. City/Town APPROVED (OFFICE USE ONLY ' Type of Plumbing License ice se Nuu�� Master 12/joumeyman ❑ G MONO wig 1 •.' .�-..------ .............. M IV 019 9 •.' ------------------------- "• MWOMMiiiiiiiiiiMiiii iiiiii (Print or type) Installing Company Name Address E. J. Plumi Check o Certificate Corp. •i Partner. Firm/Co. Name of.Licensed Plumber- Insurance lumberInsurance Coverage: Indicate the insurance coverage by checking the appropriate box: Liability insurance policy Cry Other type of indemnity 11 Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above F three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa�>settpState PlumbingCo"�Chapter.142 of the e General Laws. City/Town APPROVED (OFFICE USE ONLY ' Type of Plumbing License ice se Nuu�� Master 12/joumeyman ❑ ..- _a 4$ CERTIFICATE OF USE &OCCUPANCY Building Permit Number. 1 Sq OwITI-iTir Date // - `r�, 0 a THIS CERTIFIES THAT THE BUILDING LOCATED ON g©© 1 U r k) P) 4fQ (S/_ SL, MAY BE OCCUPIED AS 0 12'(' C.' ,5 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. "° "r" , CERTIFICATE ISSUED TO f'N t�1 G f d /�S�h7 �Pi71�S p ADDRESS000 KP—(s Si.),)c 1 b�7- � r '°d,CMUS Building Inspector m M m m Cl)V m CO) CD az Cl) CLd 0. acc .0 O CD CLQ CD O CZ O Cfl CCD CCA CD 0 H d d 0 y 0 CA d CD rF CD CD 3 y CD CO) I C PIP C?1O _ O -•N<Q y So E.0 m •o CO o ? m C7 C GO 3 m Z • P ? p ca o � � OL " -n Z CD.► N y O -Im N O O 0.0 -4. O a a . 7 3 C CD 01 O N c W a G m � C a N '� o *4 mom • C H :� � O m to RD O O N ` N d IM:cr H C7.CCD CL : � co,.r m�N cog N O O {C w O 0 CD 0 �CD N 1 dip CO C o CD �cc) 0 �z 5 4 M - x T A tri a n y O x omi 0 K ] 171 AD i.Lv ENSt PE 's 0 0 z ca _QO Q; >ai QR uj rA Aa CDW C� 0 �[ m U a z3 W ,Li G m �- Z oca ca t� u_ O rOcaLU V U C O 2 8 ca K ] 171 AD i.Lv ENSt PE 0 co U U 0 0 C40 ri) d d 0 0 a4 0, zA U U C� c� ,Li td E� O U w c W v. w 0 0 cA z 0 ED 0 Cd 4" O U U G c E- ut Q, Q, o � U U .� ® 4v4-1 LM u .05 a a � 0 0 O O ° G02 0 O . 4-1 W 0 134 C?00 C� Q �s bip @ o 0 a U Q GO a) 0 co U U 0 0 C40 ri) d d 0 0 a4 0, zA j LocationL /<'- 1 �- r No. S Date NORTH TOWN OF NORTH ANDOVER .. 9 Certificate of Occupancy $ 9 Buildin /Frame Permit Fee $ = ' s�cMust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r\ Check # -",/ i rl 361 / Building Inspector Date WOW/t%IZMIR ,TOWN OF NORTHANDOVER 27 CHARLES ST APPLICATIONF-OR, ERTIFICATE-OFINSPECTION () Fee Required (Amount) �1'6y O No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,15, I hereby apply fo, Certificate of Inspeet4on for the belaw-named premises -located at -t -he followingaddress: Street and Number Name of Premises T]-&'% Puipose for ;which Premises is L Used D/'/r� e e--' '�- Licenses (s) or Permit{s) Regnired far the P-r-emises by -Other �Ga-vernmental Agencies: License or Permit Agenc Certificate to be issued to Address E Owner of Record of Building____ fn Address ',jf14es. )—' Name of Present Holder of Certificate Name of Agency, if any J.o C SIGNATURE OF PERSONS TO WHOM CERTIFICATE IS ISSUED OR HJS A-UTHOIRIZED AGENT INSTRUCTIONS: C'ec, Telephone TITLE DATE 1) Make check payable to • Town of North Andover 2) Return this application with your check to: Ilu� Dept 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying _EEE must be submitted for each building or structure or part thereof to be cert 3) Application andfiee must-be-receivedbeforethe-certifikate w dl -be -issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # EXPIRATION DATE: FORM SBCC-3-74 REWSEB 2199 jmc TOWN OF NORTH ANDOVER INSPECTOR'S NAME OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE, f- INSPECT*N-REPORT fflZM f - r CLASSIFICATION PASSES INSPECTION yesXno 0 OWNER _ �P�f2so/t% QCT BUILDING NAME OR STREET LOCATION_ E l 147f n -� DATED 0"/ to s � Su' 4e / 0 / TYPE OF OCCUPANCY - Day -Care-Center E #fd. 0 -CaM D -Gyfil B Apt- 0 I School 0 Common Victualer's 0 Liquor 0 Place of Assembly 0 Other 4 is r OCCUPANCY NUMBER 4include-stWes -# aid-occuaarm per -#lour - wse-revere side STAIRS PROPERLY RAILED yes Er no 0 HALLS AND STAIRWAYS LIGHTED yes -43' no 0 RADIATOR GUARDS yes 0 no 0 COMPLIES HANDICAPPED PERSONS LAWS -yest'B' eO fl FIRE RESISTANT CURTAINS O' R DRAPERIES HOW HEATED r 1� INO. FIREPLACES yes no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS n NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS ll SHOPS 0 FOR INSPECTOR USE ONLY Revised 2/99 imc EXISTINGa EXIST SIGN yes 4r no I� LIGHTED EXIT SIGNS -operable 'yes'91, -no EMERGENCY LIGHTING SYSTE M operable .I1 dry cell,e wet cell 0 SPRINKLER SYSTEM operable " gage pressure yes no SMOKE DETECTOR operable yesZ no FIRE ALARM SYSTEM expiration -date -yesx eO ANSUL SYSTEM yes no--,ff' FIRE ALARM SYSTEM operable 0 municipal fl yes no 0 1 ELECTRIC EQUIPMENT PROPERLY PROTECTED yes no 0 EGRESSES LAWFULLY DESIGNATE unobstructed jyes 'e -no 0 STAIRS PROPERLY RAILED yes Er no 0 HALLS AND STAIRWAYS LIGHTED yes -43' no 0 RADIATOR GUARDS yes 0 no 0 COMPLIES HANDICAPPED PERSONS LAWS -yest'B' eO fl FIRE RESISTANT CURTAINS O' R DRAPERIES HOW HEATED r 1� INO. FIREPLACES yes no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS n NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS ll SHOPS 0 FOR INSPECTOR USE ONLY Revised 2/99 imc U U 0 0 L C.) LO cfl 0 z 04 o f� U W N 0 00- OW CCS Q a, a) a. 4-' U U m 1 � LL oO00) W O I_- H 0 0 v z� L — 0 m i- U C CO LLI '0 O E 4-� co c U U 0 0 O O 0 0 CdCd N4 a OEM A 00 o� ooa U . .. C.) Q, 04 .Li CCS CCS 4-' U U 4° �U E 4-� W . > c� p 0 .j U) V) Q Z � � U d O � w z O H' 0 U U w C O O Ctf CCS D u N m U) +� 0 UJ V) W u P4 4 0 0 0 p J.O 04 .4 U O W Cc O O x a x w 0 t� 00 p J a� � z� 8 U a o 0 �°U 4. O O 0 0 CdCd N4 a OEM A 00 o� ooa U . .. Q Date .... 6 N"A TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... .... `-'!f? SS's 7 ...... .......................... has permission to perform ..... L�i�, Uri<.:�-:.... f...` wiring in the building of .... �/ .�......7�`e7 /........................................... 90,0 at .......................t/U..... K....... ........... ,North Andover, Mass. Fee P. Lic. No .............. ...... . c! r' r—�°� .......... ELECTRICAL II�ISPEC'f'OvA� 14 Check /t !—tv 576u 11W L U1VJLY1UJV VVrW'UJ n yr ir&saarx,ay.wi 10 �•••w - �•••, DEPAWMENlOFPUME AFM Permit No. 7 6 d BOARDOFFMPREV&M0NRFJ ,MH0NSN7a R12•(ib �o ; c�© i Occupancy & Fees Checked APPLICA77ONFOR PE WTl O PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORYectrnica'l rH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMDate Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to JArfotm the work described below. Location (Street & Number) Fob /ull-I„ •/ �,Q s owner or or Tenant L, / e Owner's Address Is this permit in conjunction with a building permit: Yes [D No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Plumps . Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections E3 No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tuba No. of Motors Total HP OTHER- It&==covwgr_ PtzmtiDdrmquitamat dNi%mdiamCalaWLaws Ihaneaama�tLiabtlityhatc�FbGcYitrirdr>gCor►ple� alsstlbsrrialaquivalaY YES ED NO Ihaveahrimdvabdpoc(ofsmmi3t cOffi� YES ffymWmdrdlodMplea9eir�dr*&typeofw�mWby dzcu gthe . box U INSURANCE BOND r7 OIM [::] rem**) Estirl *dValteofE1XbcalWbdc $ WadctDStat ,g� � hspeWmD*ReWesldd &*Ftrnl FIRMNAME Li=wNa A 3� �3�Ca �, � Q� AItTUNd-a9r�-5�95s OWNER'SINSURANCEWAIVER;IamawarethattheLsedoesnothavetheit nr=w&Vcrilssubstat"et)mletasmgtmdbyM=dmmGt:naalLaws anddrtnTyagttahmendupetm fficabmwairesdti regm'ernat (Please check one) Owner 1:3 Agent Telephone No. PERMIT FEE $ signature or Owner Of Agent