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HomeMy WebLinkAboutMiscellaneous - 85 FLAGSHIP DRIVE 4/30/2018 (12)a 0cx�' 1 NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street North Andover Tel: 978-688-4545 Fax: 978688-9542 BUSMESS FO" FOR TOWN CLERK DAT! : 1/17-012 NAME: 066f) - .ADDRESS: �N. 5 s kU `i C ZONI NGDISTRICT:, TYPE OF BUSINESS:. L'-hA s cG'pi^!4 14 BUILDING LAYOUT PROVIDED; A.VAILABLE PARKING SPACES: 5 ZONING BYLAW USAGE: As -- NO BUILDING INSPECTOR SIGNATUP.E BUSINESS FORM FOR TOWN CLERK p9840 1W Date.. 17—-16-10 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that T'�% Gj has permission to perform ......................r,..................................................... wiring in the building of ... �!/x2 e. L D� S T�� .. .............. at ....1a aC . � f . s' ...r% ............................... orth Andover M Iv �2s-da .... Lic. No. C RICA. IWECroa Check # 131R _ / Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. aft Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / 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)_ P Lt± G IGk 1 Q T(>Z` l j 6 S V 6 A+ 6 Owner or Tenant ®W,•( -0 Alms ', (-p tkS1hQ Telephone No. 918794R'��,�► Owner's, Address _5; �c 6-$ e Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Qepl F Utility Authorization No. �1 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service NJJA Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical. Work: No. of Recessed Luminaires - No. of Ceil: Susp. (Paddle) Fans . v rr w co. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- El rnd. rnd. 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. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons ................ KW """ ................ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑Municipal [1 Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of Signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 o perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Tlf�s �A (Signature LIC. NO.: (If applicable, enter " xe pt" in th license number Bus. Tel. N0.• Address: 1 "2 1 c-) Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work r quires 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 PERMIT FEE: $ Signature Telephone No. r,,J rl-�J- 97S7 Date .......(..(...`....:... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies thatE 5 e07-7- /4,f-e-7-S�,e� ................................................................................... has permission to perform ............. J f%� ... �rrl!'. .�.r..... IAI ,,��jj wiring i the building of .............. O !.. S .� C tom,. Gl f r �.�J........'..�............... at ....... ....... % ! / ......L .... �, orth Andover,, Mass. _ "c2L_ Fee ... �. ?:�......... Lic. No 26d c�� ............. �„CTQ �..... EtxcrxtCAl. IrtspECTO Check # 417-52— Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 175 Occupancy and Fee Checked :ev. 1/07] (leave hlankl 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 INFO TION) Date: ///3/`d City or Town of: To the Inspector of Wires: By this application the undersi ed givis-nifliFe of his or her intention to perform the electrical. work described below. Location (Street & Number) 95 b r, Owner or Tenant Owner's Address arG Co ri OLi I,/- C KVISS Pc scoe.\ v. Is this permit in conjunction wi 1 a buildi permit? Yes LV Purpose of Building �eoGtt I p j�i,...eS Telephone No. 97b - No ❑ BLDG PERMIT # Utility Authorization No. Existing Service t o Amps 00/Z71 Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Undgrd No. of Meters Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: 1) rc e- nffL, f 17.., 1-L1- - . L_ _ _ r_ .r_ No. of Recessed Luminaires -Co—llfilm . •�� •• .... a No. of Ceil.-Susp. (Paddle) Fans .uu o iuuy ua WE49YUU Uy WX JnS eGLOr OJ YYZY2S: No. of Total. Transformers KVA No. of Luminaire Outlets /2 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ El o. o cy ig mg rnd. gr Battery Units Units No. of Receptacle Outlets 12 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches �p No. of Gas Burners No. of Detection and InitiatingTotaDevices No. of Ranges No. of Air Cond. Tons l No. of Alerting Devics No. of Waste Disposers Heat Pump Number Tons KW ..... ....................... . No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems:* No. of Water No. of No. of or Equivalent Heaters KW Signs Ballasts Data Wiring: ;. No. of Devices or E uivalent 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: �U (When required by municipal policy.) Work to Start: 0 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 Icertifies that such cover a 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 thein ormation on this application is true and complete. FIRM NAME: GSeo Z-%` '-�� G LIC. NO.:e7 gZ Licensee: as -,,770 - Signature LIC. NO.: Fi (If applicable, en er exempt" irk the Pcense n, er line. Bus. Tel. No.: �6 Address: i C.o40 I erf e- (J�- i!'1��56® e' o h'If� d��?% Alt. Tel. No.: ?� 5 8� *Per M.G.L. c.147, s. 57-61, security work requires D partment of Public Safety "S" Licen 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: $ The Commonwealth of Massachusetts Department of Industriar.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UIP www.mass.gov/riia Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectri.ciansfplumberg Applicant Information )Please Print Legibly Name (B.usiness/Organization/Individual): , scol7_ c, Address: l d Coo /t/ b . City/State/Zip: h g -k ° 6�7 D�� hone #: ?76 Areu an employer? Check the appropriate box: 1. a employer with 12 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 S. ❑ 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.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling . 8. ❑ Demolition 9. ❑ Building addition 10.Q Electrical repairs or additions I l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #l. must also fill out the section below showing their workers' compensation policy information. T 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 insurancefor• my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: 1N C v207 8 7 16 '1 Expiration Date: ?Z/ /t Job Site Address: a5-f+a 5S p v City/State/Zip: /�� /}r✓d� "�"� /�!�• 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 ofperjury that the information provided above is true and correct. - /��iy Si ature: "�`-^ /;/ Date:�L Phone #: z 29 . 6,K7 $3 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permuit/License # Issuing Authority (circle one): 1. Board ofE(ealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ;e Date...... ..�..- n..rl. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ............................................................... ZD has permission to perform .......... `S cca! , 7-. /sem: d............ i�� wiring in the building of . y!..!..7-�l't...? �: ....,'1���.....!�SDC /.,� a -� �// v�r� ,North Andover, Mass. at ..., ` .. . .c! `.. .r r.. :Z .......................... 7 Fee.V... �-�©. Lic. No....ys... ................. 1� rE criuCAL IMPWMR Check # �a V17 ti 86<<8 Clmmonwealili of MaelacLjeR3 h 2�pariinent of ire Yervice! BOARD OF FIREPREVENTION REGULATIONS r Official Use Only Permit ;'Io. Occupancy and Fee Checked [Rev. 1/07] (lease blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the \Massachusetts Electrical Code (`YMEC). 5_'7 COIR 13.00 (PLEASE PRINT 1N f'VK OR TYPE ALL J.VF WLAT.ION) Date: Citv or Town of: 00r4F) �_ To the Inspector of Wires: Bythis application the undersigned lives notice of his or herrr__intentio to perform the electrical work described below. Location (Street R Number) �J S k , (` . _ ^uAt-_1 Owner orTenant t OAC _ �C> Telephone No. 92SM 34 Owner's Address k_ i Is this permit in conjunction with a building permit? Yes. ❑ No (Check Appropriate Bos) Purpose of Building Utility authorization No. i Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New -Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacin rr c Location and Nature of Proposed Electrical Work: �, 5 Lc l [G t ey, D L \P r 1, n rf-1, • P•....... 1...:..., .. r,L fll.....:_,-._LI_--_. L_._. __.._J L_._1__ r._______. rt•. __ No. 'of Recessed Luminaires No. ofCeil.-Susp. (Paddle) Fans f Total No. oTranformers KVA No. of Luminaire Outlets No; of Hot Tubs Generators KVA No.'of Luminaires Swimmin Pool Above in- g "'rnd. ❑ grnd. ❑ t o. o mergence Lighting Battery Units No. of Receptacle OutletsI 'o. 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 N, o. of Alerting Devices No. of Waste Disposers Heat Pum Total P Number Tons -- KW' - No. of Self -Contained Detection/Alerting Devices No. of DishryashersMunicipal Space/Area Heating KW Local ❑ ❑ Other n No. of -Dryers Heating Apphances Kir curity Systems: es or Equivalent jot Nu. of Water i Heaters No. of_ No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No: K}'',dromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 0,)( OZ�`�-J'�—�3 I Attach additional detail V desired• or as required by the Inspector of If"ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon cc:npletion. INSURANCE COVER_ 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 unde: signed certifies that such coverage is in force, and has exhibited proof of same to the permit issuing• office. CHECK ONE: INStJ^.ANCE (.2 I301`11) ❑ OTHEP ❑ (Specify:) Self .Insl:red 1 ceriij ,, under the pains and penalties of perjury, That the t ormation on this applicatio•c is true and complete. FIRM NAME: ADT Security Services LIC. N'0.: Licensee: , Mark A. BrOphV Signatu e LIC. NO.: C-4 (If apt.licable; enter "e-.enpt" ih the license Lumber line./ Bus. Tel.No.: E 0 3 - 5 S 4 - S_9 2 8 Address: 18 Clinton Drive Hollis, NH _�,c,. Alt. Tel. No.- '309S3 o.: _ Per M.G.L. c. 147 s. 57--6 1, securiC� work requires Department of Public Safeq "S"License: Lic. No. '3 0 9 S 3 OWNERIS-INSURANCE NVAIVER: I am aware that the Licensee does not have the liability insuranc•: coverage norna'ly required by 1.aw. By my signature below, [hereby waive this requirement. I am the (check one) ❑owner [] own is agent. Owner/Agent Signature _ Telephone No. SPF.hIIT FEF.: ,� _ _ - Lip Date.Z/ // l T � f pORT/ 4,oma TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to perform-/ .% i �f / i / / K j- wiring r in the building of.. �:..�*�%.. at r.. /i�..r... " I J ............ . North Andover, Mass. J1 Fee.. .l...... Lic. No.. ELECTRICALINSPECTOR � Check # / t � ✓ /J( 4 : 5 c t 0 .N Commonwealth of Mas: Department of Fire S BOARD OF FIRE PREVENTION I APPLICATION FOR PERMIT All work to be performed in accordance wii (PLEASE PRINT IN INK OR T AL FO 1 City or Town of: r 11 By this application the undersigned ives noric o his or Location (Street & u ber) Owner or Tenant 11 / -1 A/ /A 17 r Owner's Address /LATIONS Official �ALy� Permit No. Occupancy and Fee Checked [Rev. 11/99] leave blankORM ELECTRICAL WORK the Massachusetts Electrical Code (MEC52R 12.00 TION) Date: ilW,14 4i To the Inspe for of Wires: er,intention iyQerform the electrical work described below. Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No W (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: Installation of Security system Cmmnlvtinn nftha rnll—d— mbla m , 7—,.,.,1.,xd ; ., #1— G,....,,,.•1.... l idR 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 AboveIn- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o 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 [1 Other Connection No. of Dryers Heating Appliances Kit Security Systems: No. of Devices or Equivalent No. of Water Kit Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HF Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail iil 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:) (Expiration Date) Estimated Value of Electrical Work: _ (When required by municipal policy.) Work to Start: JZ416±Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Services LIC. NO.: 1 51 it Licensee: John S. Bassett Signature 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 Lid, 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: ,$ ,