Loading...
HomeMy WebLinkAboutMiscellaneous - 946 OSGOOD STREET 4/30/2018 (3)f n. 0 Q �uj �o i Date.... S,—.. / — /. 2, ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................................................................... Ge....... has permission to perform .............. Z ...... 7! v9q ....... c4gtv) .......... wiring in the building of .... C� "Sion ............................ at ..... . . .......... ......... North Andover Mass. oe' ... Fee.12-S --- T ic. No. .17z -Z54 ...... ....... E**c"r ................ R'[C*A*L'*INSP'*"' 0 -R - Check # 's—f `10820 Commonwealth of Massachusetts Ofllcial use O�nla', Department of Fire Services 16 Q permit No. DG=--C� = Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) ^\ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' \ All work to be perfornied in accordance with the Massachusetts Electrical Code (M :C), 27 CMR 12.00 a (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / City or Town of: k, A yo— To the Ins e for of Wires: < `\ By this application the undersigned gives notice of his or her inten�ton to perform the electrical work described below. Location (Street & Number) S S/. Owner or Tenant 6 i -c"' Telephone No. Owner's Address Is this permit in conjunction with ailding ermit? Yes ❑ No 12/ (Check Appropriate Box) Purpose of Building he Ya 7h Utility Authorization No. Existing Service Amps /ZO / Z,6 WVolts Overhead [a Undgrd ❑ No. of Meters !, New Service Ams / Volts Overhead Amps ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �j��PrPS ('ontvle(ion of the follow nr tohle mm, he wniced hr the hfcnertnr of Wirec -1 A No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. grnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets /0 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pump Totals: um er ons KWf " ' .......... 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 o. o o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: ,e a A1111ach additional detail if desired, or as required by the Inspector of lf'ires. Estimated Value of lectrical Work: Sae), (When required by municipal policy.) Work to Start: / Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE O ERAGE: 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 certift�, under the pains and penalties of perjurt,, that the information on this application is trite and complete. FIRM NAME:Tnc-LIC. NO.: 17238A 38A Licensee: Richard J. Arel Signature LIC. NO.: 27514E (Ifapplicable, enter "exempt"in lite license number line.) Bus. Tel. No.: 978-372-1601 Address: 77-A toast,; n tern ekrgek,--H21rerhi 11� MA Alt. Tel. No.:97R—Ing-9Ia,l *Security System Contractor License required for this work; If applicable, enter the license number here: OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below. I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent / Signature Telephone No. PERMIT FEE: S / 2 S r4llv lot 0/,c P`7 4 Date ....... 1..—..z. ...... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .........4/.,.�.. ........� ............................................ has permission to perform ...... C.!.6.1........1 1tl...l!................................. wiring in the building of ..... t..1` (I"' j....% Go S i_ vfil at ................/. ...7..... `' 5%��!✓...... SNorth Andover, Mass. ..-................... , Fee, 2 S Lic. No. J t (7 Z �8h2/../1..... ELE TRC NSP CTOR Check # ins I Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. [ 2,5- V Occupancy and Fee Checked ,[Rev. 9/05] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MF), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: Z City or Town of: Ah Ahll�ay�t� To the Ins ctor of Wires: By this application the undersigned gives notice of his or her intentiogto perform the electrical work described below. Location (Street & Number) X41& (?S T Vy 57• Owner or Tenant C11 p!( , jf/Q, jf o M Telephone No. Owner's Address Is this permit in conjunction with s buildin rmit? Yes No ❑ (Check Appropriate Box) Purpose of Building 6;4= i Utility Authorization No. Existing Service kAO Amps /,?,0 / 068 Vohs Overhead Ea Undgrd ❑ No. of Meters New Service Amps J Vohs Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location andNature of Proposed Electrical Work: I t Comvletion ofthe followine table may be waived by the Insneetor of Wires. No. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans r o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool de ❑ Ind, ❑ BatteryUnits my g No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of DetInitiaection Devices No. of Ranges No. of Air Cond. To s No. of Alerting Devices No. of Waste Disposers eat mp_, Totals: nm _r, T ons ........... o. o Self -Conte l[Wection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Conner ion ❑ Other No. of Dryers Heating Appliances KW Securityems: No. of vices or Equivalent No. o Water KW Heaters o. o o. o MS Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWFrgg No. of Devices orEquivilent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lectrical Work: /S� - �° (When required by municipal policy.) Work to Start: �,� y 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: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the informadon on this application is true and complete FIRM NAME: LIC. NO.: 17238A Licensee: Richard J. Arel Signature LIC. NO.: 27514E (If applicable, enter "exempt" in the license nwnber line.) Bus. Tel. No., 978-372-1601 Address: Ah. Tei. No.: 97R-309-2127 *Security System Contra&r License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner El owner'sa ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. • The Consmonwealth of Massachusetts Department of k44 trial Aceidenis Office of Invesdgakons 0 W,4shington Sireei f Boston,'..W 021II www.mas&gov/dfa Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansJPhimbers Applicant Information Please Print.Legitiv Name (Business/Organization/individual):....W}^ l _i ifjc&.0 Address: 7.1.3 G' r 517 ,.. n) 6n City/State/Zip:. �tV 1 !I v l�'�'Il? t . �Z.. Phone Are on an employer? Check the appropriate box: p ( T of project regi&ed): 1. I am a employer with 4. 0 I am a general contractor and. I YP.., _ .. ] . employees- (full and/or part-time). have hired the sub_contractors ❑ New construction . 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7.: [ ieinodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers'. co insurance.t 9. [].Building -addition [No workers' comp. insurance comp. required] 5. ❑ We are a corporation and its 10. E] Electrical repairs or additions officers have exercised their 3. ❑ I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[] Roof repairs .insurance required.] f C. 152, § 1(4), and we have no employees. [No workers' 1311 Other comp. insurance recauiredl - `Any applicant that checks box #I mast also fill out the section below showing their workers' compensation policy information. f 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 subcontractors and state whethei or not those entities have employees. If the sub -contractors have employees,.they most provide their workers' comp_ policy number. . I am an employer that b providing workers' compensation insurance for my employees - Below is the policy and job site - n. - informado Insurance Company Name: le%o )-a/, CX- . /ti��hs 61^ao kajAd� Policy # or Self -ins. Lic. #: WGAro 3 7— 6116 Expiration Date: Job Site Address: 'I'-/(/ GGr / •City/State/Zip: Attach a copy of the workers compensation policy declaration page (showing the policy number and expiration date). Fail' ' to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine u 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 insii ance coverage verification. I do hereby cert f der they ins andpenalties ofperjury that the information provided above is true and correct Phone #: f 7,'- 30 z - SIF 7 Official use only. Do not write in this area, to he completed by city or town official City or Town: Permit/License # 71? 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 #• Infotmation, and nstruciion Massachusetts General Laws chapter 152 requires all employers toprovide 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 emploper is. defined as: "an individual; partnership,'associatior, 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 xesides 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 also. states that. "every state or local licensing agency shaIl withhold the. issuance or w• § .. -. . renewal of a. license. or permit to operate a business or to construct buildings; m the commonwealth. for any a hcant wbio has not riiduced acceptable evidence of compliance with the insurance coverage.re., anted." PP� P. P P�q:� 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 silo=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 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 IndustrialAccidents. Sliould you.have any questions regarding the law or if you are required to obtain a workers' compensation policy, please callthe Department at the number listed below. Self-insured companies should enter their self4asuranee license number on the appropriate line. City or -i-own 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 permitllicense 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 bi 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 Of Ice 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 Offiee of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72-74900 ext 406 or 1-$77-MASSAFE Revised 4-24=07 Fay # 517-727-`749 www.n1=.govtdia A CCIR�® �j`r•���/� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/6/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER INSURANCE SOLUTIONS CORPORATION 60 Westville Rd Plaistow NH 03865 NAME: CT Linda BOgdanowicz FAX (603)382-2034 PHONE(603)382-4600T IA M^IL .lindab@isc-insurance.com INSURERS AFFORDING COVERAGE NAIC 8 INSURER Merchants 23329 INSURED Arel Electric Inc 773 Washington Street Haverhill MA 01832 INSURER B : INSURER C: INSURER D: INSURER E: INSURERF: COVERAGES CERTIFICATE NUMRFR-CL143615639 REVISION NUMBER: 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. INSR L TYPE OF INSURANCE POLICY NUMBER M�WYLDICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 Tu— PREMISS Ea occurrence $ 500,000 )i, COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE FXI OCCUR BOP1064359 /6/2014 /6/2015 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ include GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ 5_1 POLICY I PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E,. 11000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS KCPL7015690 /6/2014 /6/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X HIRED AUTOS X NON -OWNED AUTOS PIP -Basic $ 8 000 R X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ A EXCESS LIAB I CLAIMS -MADE DED I R I RETENTION$ 10,00 $ CUP9149665 /6/2014 /6/2015 A WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y / N OFFI(CCER/MEMBEREXCLUDED? In NH)E.L. NIA /6/2014 /6/2015(Maddatory E.L. EACH ACCIDENT $ 500,000 DISEASE - EA EMPLOYEE $ 500,000 If y,: , describe under DESCRIPTION OF OPERATIONS below rCAI032640 E.L. DISEASE -POLICY LIMIT a 500,000 f r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ****SAMPLE CERT ONLY**** �I b���� Q// ACCORDANCE WITH THE POLICY PROVISIONS. / S 7 AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mninns) m Tho ACORII n2mo nnri Innn nro ranicfararl mnrlre of ACnRr1 Date ..... Z.. 7.-.... TOWN OF NORTH ANDOVER This certifies that ........... &? L ........................ PERMIT FOR WIRING Z........—��.Z..... �T.................................... has permission to perform ........ G. 9 �?�... ! �'` (0UTSlD ) ....... ................................................................... wiring in the building of... . �. ! / ..............Le j...................................................... at ......... �`� l/ ................................... .... . North Andover, Mass. y aG 7 ... fel. . Fee ..l..2- S'__..— Lic. No.... �........... ...................t � r .,, ........... !ECTRICAL SPEC�OR f Check # �J v 1/ �C Commonwealth of Massachusetts Department of Fire Services , BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. z�C9T— 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 (NEC), 527 QP 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: glz2ln City or Town of: NORTH ANDOVER To the Inspec r o ices: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location (Street & Number) 0S,W,02�71 Owner or Tenant /hii,2,t A'X,.rraI-, B4`f Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of BuildingA,� 177'Utility Authorization No. Existing Service A06 Amps 106 /?,O F Volts Overhead 9 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: Completion ofthe following table may be waived by the Inspector o7ires. No, of Recessed Luminaires ✓ No. of Cell: Susp. (Paddle) Fans s Total Trsformers KVA Tran No. of Luminaire Outlets No, of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- rnd. rnd. TV-Elo. o cy 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. Tons Tot No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecNo. o Systems:* or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 10 Attach additional detail if desired, oras required by the Inspector o wires. Estimated Value of Electrical Work: %OZO. (When required by municipal policy.) Work to Start: 4 - 3 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. rju , that the information on this application is true and complete. FIRM NAME:. LIC. NO.: 7 ZJ Licensee:i f^G Signature LIC. NO.: 2`7 r� (If applicable, enter "exep " i the Zic nse natm line.) Bus. Tel. No.: Address: r % Alt. Tel. No.: `Per M.G.L c. 147, s. 57-61, se rity work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE W ER: 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. ❑ 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 IN Failed IN 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 F?] Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL, INS ECTION: Pass V Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Sign tures Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com a The Commonwealth of Massachusetts Department ofIndustritll Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name F& l'Xdlrcdll l r 1"K City/State/Zip: '� Phone #: C � Are you an employer? Check the appropriate box: M 4. ❑ I I 1. I am a employer with am a general contractor and 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. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.R(Electrical repairs or additions 11. ❑ Plumbing repairs or additions 1211 Roof repairs 13.❑ Other *Any applicant that checks box 41 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. 1Contractors 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 thepolicy and job site information. /I Insurance Company Name:. Policy # stir Self -ins. Lie. #: r'Q Qd Expiration Date: Job Site' kddress: JV6 City/State/Zip: Attach a copy of the workers' comp sation 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert fy under the pains and venalties ofperjury that the information provided above is true and correct. 0 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should ? 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 curren� policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington. Street Boston., MA 02111 Tel. # 617-727-4900 ext 406 or 1-877,7MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass,gov1dza This certifies that X has permission to perform ... (f'.............. plumbing in the buildings of. ..�?� �.. S�,ry� ............ . . . .. . . . at ..... <./.L!.....0 �r� r ...{9, North "I ovfe�., Mass. Fee Lie. No.,/O,? : !�" ... .. . PLUMBING INSPECTOR v Check # f7 c2%-, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 0 �sr-S�-ft MA DATE-15���� PERMIT# I JOBSITE ADDRESS y OWNER'S NAME C I8 cit �`3i tS$ Y� P OWNER ADDRESS TEL[_ _ _FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL © RESIDENTIAL Q PRINT CLEARLY NEW: © RENOVATION: REPLACEMENT: � PLANS SUBMITTED: YESEq NOQ FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _.__) DEDICATED GRAY WATER SYSTEM ! ..-_ € f € .___.._) ( I .__ € .___J______I ____I != f _I DEDICATED WATER RECYCLE SYSTEM (__._..._...) � ) ._.._._I f I -_._.) ( € ._..____( = = ....__.__! DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR) 4<ITCHEN SINK LAVATORY- -�_�((€ ROOF DRAIN SHOWER STALL WJF-- SERVICE / MOP SINK TOILET ..._._._.__.-.._- URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES -D WATER PIPING OTHER �� — I --€ -€ -. JNMI' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .. € NO �I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY © BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT �] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com liance with VI P rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME - ,tom t �uv►n (�-lb.� .. LICENSE # Tttij i SI RE MP2, JP Q CORPORATION Q# PARTNERSHIP_(# LLC COMPANY NAME , c � - ��t1Qtis1,,0 — ADDRESS _ p,� ire _jp 1_! _ CITY �,�il,� _ _...._......___.._ STATE I ZIP —� �i,3 I it TEL FAX!f'S?(-(Itilj CELL EMAIL il- ci „fin. _-ec fi`b�,.__ ._.. . F z 0 H U W a d z w � on z �o ° � W H � w zW a � O a a LU w � ° o it w� � U J a a � w = w � w H O z z 0 w INO as a � � O a The Commonwealth of Massachusetts Ln Department of Industrial Accidents Office of Investigations UT. 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: P16 -4- �'� a City/State/Zip: Phone #:_ q) F 3-11 —(') tf_� Are you an employer? Check the appropriate box: 1. am a employer with —A)- 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. E] I am a sole or have hired the sub -contractors listed proprietor partner- 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.] 3M ❑ I am a homeowner doing all work officers have exercised their 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 reauired.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outsidentractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-concotractors and their workers' comp. policy information. t am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G 0 ?olicy # or Self -ins. Lic. #:. Ex iration Date: Z / � p lob Site Address: 9'6 0 STXC'-- R05� 44"r- City/State/Zip: attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). �ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certyyunder the paihs and penalties of perjury that the information provided above is true and correct. A /11 UJftctat use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # l5 Issuing Authority (circle one): L 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-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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia �� ��, ti �� � � �� -� � �- I . 06/27/2014 08:40 6177271258 ABCC LICENSING Jun 26 2014 11:58HM TONE 9786fat3"''S'i PAGE 01/01 P.2 ns Commonwsakh Of Massachusetts Alcoholic Beverages Control CplsLW +doff. ❑ For AeConstderabon 239 Cgwtewsty Street Boston, MA 02114 • �ssra,-- r/ate . bultding; Rrst floor, lovage, dining loom, banquet rZOM kitchen. World tear two bedraoms, calcarfor 11049k 'Wofronteraranas, two Adding a patio 000 square feet with forty (40) sea>tta. Application Flled; M 2014 Advertised MaEnt4 httuttea Notified/ . yea IN No d Date & time Dite A Attach Publkatlon can" C1 Pusan for Tronsodlon IMF. David Vee Phone; 971 02-7242 AOpAES51 444 Osgood Stmmf C17YMOWN; NORT}fANt)4VER STATE Elzpcobe alieas Remarks n1 LOW JUN 2 7 2014 ABrt Remirlm � FORM43 MUST -RESIGNEb Bly LOCAL LICENSING AUT$pRITy osiaovott NORTHAalaot�t . ABW Lt=n Nbmber-1RANMVr?4nV June 9.2D1; It-~ Cityf1bwo Looat Appmyat Dat, . [] New Mcense ❑New Offlear/Dhat"t ❑ Transfer of LIcertad ❑ Pledge ttcsr, D Chanpeoilaation © Changer agate Jame (3 Change of Maneper f ❑ PJed9sofStoa�c Alterataan alLraerlsed Prerrlt6es ❑ Seasonal to Annaral ' [] Cordlaisltlqururt Perndt Q Taansfir a>lStor:k j� issuance ofStock . Q Chance of License•Typs [� 6 -1100 7 -Day Llcense Q NewStocWeldat [� Mattagement/OPerating Agreement • D 1'►rine aW Msif taAl! Alcohnt Name of llcansee Chino Blossom, Ina [IN of Licensee 04-23111934 D/MA N/A hlaneper S,nJae a:hp === ADDRFSS; 94605g"WSheet '"—" 47rIromf Nort Andawr STATE Mp 21peODfi utiles Aenual Annual orSe6onal AllAtmtiol Restaurant • i�lltir.�� p��i��M,AMi4r'lhn T,,, 7y� i�pYI1n60WPaJoq� :omplete DescriJstlon of Lkensed Aremttw. °s"r'"' Qeo+�•aBtct bultding; Rrst floor, lovage, dining loom, banquet rZOM kitchen. World tear two bedraoms, calcarfor 11049k 'Wofronteraranas, two Adding a patio 000 square feet with forty (40) sea>tta. Application Flled; M 2014 Advertised MaEnt4 httuttea Notified/ . yea IN No d Date & time Dite A Attach Publkatlon can" C1 Pusan for Tronsodlon IMF. David Vee Phone; 971 02-7242 AOpAES51 444 Osgood Stmmf C17YMOWN; NORT}fANt)4VER STATE Elzpcobe alieas Remarks n1 LOW JUN 2 7 2014 ABrt Remirlm � Date.... .--... .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING /qC&Z Thiscertifies that ......................................... ...... �.....................�...........77<< .../........................................ has permission to perform /91.1.!&K..... �%.BG�fi�L ......... /�......................................... wiring in the building of ..... i�.YG,i%. Cc�S ��!/t ................................................................... �S Sm�i j S'�-- North Andover, Mass. at................................................................................... _ 1 46 Fee ... l.-V'''Lic. No. ...z ..2.? ............. .C..... A LECTRICALINSPECfOR Z 1: u f' M Y Commonwealth of Massachusetts 01lieial I'se Onl+ -�-- Department of Fire Services Permit No. ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 111ev.9'01 tica+eblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ,\I1 \%ork to he perlormcd in accordance NI -ill, file \lassachuseits lilectrical Gude (\t(. �? t 1RI1.00 (l'LL.l.ti1: PRIAT L\( LV oR T3PE A1.1. 1:1'1()RXIA71O)A\) Date: 3 �s ,S Cit}• or Town of: �/. %y�jy`P/'^ To the /Iuptl•lvr of 1'rres: liw this application the undersigned gives notice of his or her intention tg perform the electrical work described below. [.oration (Street K Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a buildig)g permit? Yes � No ❑ (Check Appropriate Box) Purpose of Building }yr y /G Utility .•luthorization No. E \istinoService �IIZ� Amps / ZU/ 06!0 Volts Overhead I:ndgrd Q No. of deters New Service Amps I Volts Overhead ❑ Undard ❑ No. of deters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: .t!/tl('1717[7[It(1(Jt1C11 <1['1(17! 1/ (f['.a(('a'[[, rJr (r.. [a-[lrrrra-...•, ,.,. ...,,t•...... .-, . f� Fstinrtted Wattle of i= ectr cal Work: 7SU7%, (When required by municipal policy.) Work to Start: 511-7113 Inspections to be requested in accordance with \iI-V Rule iO• and upon completion. ItiSI RANC'E: (TWER:NGE:: t_ nless +waived b+ the owner- no permit for the performance of electrical work nra N issue un1 the licensee provides proof of liability insurance including "completed operation - coverage or its substantial equivalent. '1'h undersi,md certifies that such co\erage is in force_ and has exhibited proof of same to the permit issuing Office. (1IF('K ONF: INSURANCE- ❑ BOND ❑ OTHER ❑ (Specify:) I certify. under the pains and penalties of perjury, that the iil farolatiail oil [Ills application is trite and Complete. 7238A - FIRM NAME:1,110. NO.: 7) ')38 - LIC. NO.: 2751!�E Licensee: Richard J. Are]. Signature �' rli [lp;Jlk•uhir. euh•r "[tcenr;rt •• in ilii license number line.l Bus. Tel. No.:978-372— � �4'� Address: + Alt. Tel. \o.: 11 78—`�O•? 1Ib "Security S}stem ('ontractar l.,icense required R>r this +work: :if applicable. enter the license number here: OWNER'S INSURANCE WAiVER: I am aware that the Licensee does nut have the liabilip insurance coverage norniall required b} law. B\ my si,nature bclo+w. I hereby +naive this requirement. i am the (check onel ❑ owner ❑ out�er's ag Owner/:Ngent PERMIT FEE: S �' j Signature Telephone tio. No. of Total No. of Recessed Luminaires No. of Ceil. Susp. (Paddle) Fans Transformers KVA No. of l.urninaire Outlets No. of Hot Tubs Generators KN'A g lbove Eu- ❑ ❑ . o- o Emergency Lighting No. of Luminaires Swimming Pool rnd rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE A1:ARRES No. of Tones Netection and o. o No. of Switches No. of Gas Burners initiating Devices 10. of Ranges Total No. of :lir Cond. Tons No. of Alerting Devices t eat Pump Number t onsKN ' No. of.'e! - 'ontaine No. of NN rite Disposers Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KNN Municipal Other Local l ❑ Connection ❑ No. of Dryers [leafing Appliances f:NN Security Systems:" No. of bevices or Equivalent No. of NNater KNN No. of No. o Data NViring: Heaters Signs Ballasts No. of Devices or Equi Telecommunications NN firing: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: .t!/tl('1717[7[It(1(Jt1C11 <1['1(17! 1/ (f['.a(('a'[[, rJr (r.. [a-[lrrrra-...•, ,.,. ...,,t•...... .-, . f� Fstinrtted Wattle of i= ectr cal Work: 7SU7%, (When required by municipal policy.) Work to Start: 511-7113 Inspections to be requested in accordance with \iI-V Rule iO• and upon completion. ItiSI RANC'E: (TWER:NGE:: t_ nless +waived b+ the owner- no permit for the performance of electrical work nra N issue un1 the licensee provides proof of liability insurance including "completed operation - coverage or its substantial equivalent. '1'h undersi,md certifies that such co\erage is in force_ and has exhibited proof of same to the permit issuing Office. (1IF('K ONF: INSURANCE- ❑ BOND ❑ OTHER ❑ (Specify:) I certify. under the pains and penalties of perjury, that the iil farolatiail oil [Ills application is trite and Complete. 7238A - FIRM NAME:1,110. NO.: 7) ')38 - LIC. NO.: 2751!�E Licensee: Richard J. Are]. Signature �' rli [lp;Jlk•uhir. euh•r "[tcenr;rt •• in ilii license number line.l Bus. Tel. No.:978-372— � �4'� Address: + Alt. Tel. \o.: 11 78—`�O•? 1Ib "Security S}stem ('ontractar l.,icense required R>r this +work: :if applicable. enter the license number here: OWNER'S INSURANCE WAiVER: I am aware that the Licensee does nut have the liabilip insurance coverage norniall required b} law. B\ my si,nature bclo+w. I hereby +naive this requirement. i am the (check onel ❑ owner ❑ out�er's ag Owner/:Ngent PERMIT FEE: S �' j Signature Telephone tio. Date ....... 1 z 7— 1.4... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................ E ............. ........ has permission to perform ......... 7./Lp....G. ................. wiring in the building of Go S' L.� 5.. Q... S at ...../...... ........ .C.�....�................ .North Andover, Mass. 0'0 Fee.. {.. Z 5'� Lic. Node.. 1 0 / ............. .... �........... ..L.............. ...... . E cmcAL INSPEcr0R Check # 10621 L S� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. f n �^ 2-1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99) (Icaw blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:--./ _a 3 - / A City or Town of: n4L, A t.)-Itszwc it 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) C11/4, a s G CSD ll. S Owner or Tenant C k4 14 �` S�nt� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No OK (Check Appropriate Box) Purpose of Buildin Existing Service _ New Service Amps / Volts Amps Number of Feeders and Ampacity Volts Location and Nature of Proposed Electrical Work: Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters ('a'? Irvin n(it, n f ll.,...:„.. —hl— I.- ..,a r... d__ No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans ere .rur.•cu ur free 111,31muul v rr (rCJ. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. end. 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. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons I KW t No. of Self -Contained Detection/Alertina Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal [3 Other Connection No. of Dryers No. o Heaters KW ater Heating Appliances KW o. o o. o / Signs Ballasts 3 SecurityNofDevicesor Equivalent 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 detod ifdesrred. or as required br the Inspector of Ifires. INSURANCE COVERAGE: Unless waived by the owner. no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation” coverage or its substantial equivalent. The undersigned certifies that such cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: 690 (When required by municipal policy.) (Expiration I)ate) Work to Start:] Inspections to be requested in accordance with MEC Rule 10. and upon completion. I certify, under the pains and penalties of perjury, that the information 05AOIIF application is true and complete FIRM NAME: E GT t C i C f 0 LIC. NO.: MPI -/0q -!S Licensee: N1:AQerT WI e rr Vy►1►4 0 Sig_ natu (lfapplicable, enter - empI " in the Peens nuinber lin Address: OWNER'S INSURANCE WAIVER: I am aware that the I icensee haes required by law. By my signature below. I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: Alt. Tel. No.: not have the liability insurance coverage normally 1 am the (check one) ❑ owner ❑ owner's a ent. PERMIT FEE. S IQ j — V .1:4 The Commonwealth of Massachusetts Department of Industria/ Accidents Office of Investigations 600 Washington Street Boston, MA 02111 IV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builder-/Contractors/Electricians/Plumbers Aniplicant Information Please Print Lefaibl Name (13usinc%vOrganiiation/Individual)::W� Address: ya�tAS>RU._t_ 5.1 _ City/State/Zip:5to Nt}y►1�vv1 Y,_ C2a.1%U Phone H: 751 Are you an employer? Check the appropriate box: ❑ t am a emplover with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).` 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in anv capacity. [No workers' comp. insurance required.) 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.]' have hired the sub -contractors listed on the attached sheet. These sub -contractors have `workers' comp. insurance. 5• j��j We are a corporation and its officers have exercised their right of'exemption per MGL c. 152. Z 1 M. and we have no employees. )No workers' comp. insurance required.) y 35 -vel 3a Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 I -El Plumbing repairs or additions 12.❑ Roof repairs I .. ❑ Other 1 � .. _". no out tnc section nriaw snowing tlxrr workers' comrvnsauon rxdiq information* rIM—mens who submit this afFidav I indicating thch are doing all work and then hireoutside contractors must submit a nc%% at ida%it indicating such ^t'antraetors that check this box must attached an additional shctt showing the name of the %ub-contractors, and then %orkcn' comp polio mfexmaucm I ant an employer that is providing worker:-' compensation insurance for nrt• eMplgfees. Below is the polid�r and job site information. Insurance Company Name: 400 Ri SC Se rv,ce 5 , Io(_ c) Policy or Self -ins. l.ic. (J C U CI d Gi 7 r, M AI.xpiration Date: 71 i / ) Job Site Address: p: V30r J,e Au�o6c 1 "'6 1-1 C ih State !i 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 M(il . 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. Bc advised that a coPy of this statement ma% be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /da hereby cerli� / T ns d penalties ojperjurr =hay injornwtion provided =bore trae and correct Phone #: Oficial use onht Do not write in this area. to be completed lot• c•itr• or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board Of Health 2. Building Department 3. C'itv/-I'own Clerk d. Electrical Inspector S. Plumbing Inspector 6. Other -- Contact Person: Phone #: Date. .1 !:/.!Z......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �SACMUS` 1 This certifies that .. C�Q.��a.�...�....... .. 6. has permission for gas instt11 tiony�. in the buildings of ... !?!�?`* .1�f-e SSo/yI ...... . .......... . at . ........ , Nrth ndover,/Mass. Fee�' �o Lic. No. IVZ GAS INSPECTO •.••• Check # o e vZ i,r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 012 / .JlJ E MA DATE /- PERMIT # � JOBSITE ADDRESS Q 0 OWNER'S NAME ��/U/f- per/ x GOWNERADDRESS TEI FAX TPYPPENOTR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL E] RESIDENTIALEJ CLEARLY NEW:0 RENOVATION: F -j REPLACEMENT: PLANS SUBMITTED: YES NDE] APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ( i BOOSTER _ ...� .�� � _ ,...-.._ �. ..�.. '�---'_�.ro L CONVERSION BURNER I _ �! _ �: _ g COOK STOVE _. DIRECT VENT HEATER DRYER_ �n« FIREPLACE _ r_ W' __ _ FRYOLATOR FURNACE GENERATOR �__ , GRILLE INFRARED HEATER__ _. « LABORATORY COCKS MAKEUP AIR UNIT,_«. OVEN _ POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT r___.._..:.. I ` _ TEST � .!. .n . ten. ., ..._»...... rvm UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER .�. , «_ ......c...c I «. .J7 mm" _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY j OTHER TYPE INDEMNITY [j BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER,j AGENTi SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations perfonned under the permit issued for this application will be in compli ith all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME E JEFFREY HUTNICK LICENSE # 15212 SITNATURE MP MGF L:j JP JGF LPGI i� CORPORATION [:,],# 2840 PARTNERSHIP J# LLC #= COMPANY NAME:CALLAHAN AC AND HTG ADDRESS 1911 BELMONT ST CITY , NORTH ANDOVER STATE =ZIPI 01845 �.. TEL 1978-689-9233 FAX,r,._ CELL=_. REMAIL The Coinrnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Roston,119A 02111 www.rnass.gov/dia Workers" Compensation Insurance Affidavit: Builders/Contractors/Liectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgtuiizatioti/Individual): Address: (%i /,-) w//;7,, //`- Cit} /State/Zip: hone #: Are you an employer? Check the appropriate box: ` l . ' 1 ani a employer with ->Z 5— -"' 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. L] I ani 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.] 3. ❑ 1 am a homeowner doing all work myself [No workers' comp. insurance required] t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL 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 l LE3'PlLa ibuig repairs or additions 12.❑ Roof repairs 13.E] -- *''lily applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. T t lonteowners who submit this affidavit indicatutgthey are doing all work and then hire outside contractors must submit a new afliduvit indicating such. $Coiaractois that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have entpllyecs. Ii the sub -contractors have employees, they must provide their workers' comp. policy number. 1 am air employer tit at is providing workers' compensation insurance for my employees. Below is thepolicy and job site /reformation_ Insuratice Company Name: 6t( Policy # or Self -ins. Lie. #: / /� (� e� l� & / t`) /9 Expiration Date:_ Job Site Address: / Lf /f I'm 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 cri.mi.nal 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 acid a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to die 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. y._. 2 ;2 —,,.2 a// Phone #: y-1 t Lr rf Ojjtcial use only. Do not write in this area, to be completed by city or town ojjiciat City or Town: Permit/Li�ensix td ___ Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. I'lunebing Inspector 6. Other Contact Person: Phone #: 989 Date .......1.'..�� . `�:./...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING le This certifies that ....... ' 1..:...4....... ...... has permission to perform...... W!T/�: �..... Gf� .......... .��� .......... wiring in the building of ...... (.1,K... l fL?........5?` ............................. at ......... �1�/`Y!........... , North Andover, Mass. ...... ........................ . Fee/!�... Lic. No..1.. ..z 3? ... �..... �' ....... ELECTRICAL INSPECTOR Check # i.arruaeaawaafth a /j/ecssaclisraQlfl ! official t;se only Permit N11747 BOARD OF FIRE PRFVEINM N REODLATi0fgS I Occupancy and Fee Checked 2 t1991 {leave btankt �� APPLICATION FOR PERMIT To PERFORM ELECTRICAL WORK All work to be p_rfar-vcd in accordance with t,`rc Mil -S achusctis Electrical Code Vk,19 52-, amp, 12.00 (PL EASY- pR11VT I.V INK QR TYpL• ,4[ I rY1 I��Lt7iC3rYj DfC: City or Town o:, t Zc�3n,� GVy^ � - �y l/ To the I):speetor of fYires: I3y this application .l:e undersigue �ives f hertertiou to perform the electrical work described below. Location (Street & \untFtcr) ?11 (o t`�S<.r,,),,) /T ' Owiter or Tenant Owner's Address Is this perillit in compunction with a building permit? Purliose or Building Existing Ser-eicc Ansps 1 'Vutts af ats_Scrv�ice Amts / Volts Number u." Feeders and Ampacity Location at.ts Mature of Proposed E yes ❑ No Telephone N (Check Appropriate I3ox) Will v Authorization No. Overhead Undgrd Overhead E] ilrtdgrd ❑ No, of deters No. of hleters No. of Recessed Fixtures i-r<r.7rrirox cr r:re;orruru%r table rrrav be u -awed by Ike b - error of Wires. . No. of Cell. Susp. (P2ddle; Fans t o• o ota I'raissformers No. of Lighting Outlets No. of Hot Tubs XVA 'Generators K%VA No. of Lighting Fixtures Swimming Pool A °� e ❑ Ir - ❑ ! �o. o, mergettcr sg usng rad., d• Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALAR,IIS lNo. of Zones No. of Switches lido. of Gas Burners j o. oDetection and Initiating Devices No. of Ranges Tom-, No. or Conti. Tuns Na. of Alerting Devices ,No. of NVaste Disposers eai unrp S uIIt er . osts � � V� —'-___`_, t a. a elf ontainc i Detection/Alertin Devices No. of Distn ushers �SpncejArea Heating KNV Local ❑ Connectionni❑ Other t `t of Dryers Heating Appliances KW SecuritySystems:. No. of Water No. of t o. of Nn of r% ices or Equivaleut i i FIeatc s KIV marts I3sIlasts Data SVtriva- No, ofl3erices or Eanivsient No. Hydromassage Bathtubs No. of Motors Total I Il' !'c ecommunications wirirtg: No. of Devices or E trivalent OTHER: j Atrach additianal detail if desired, oras required by die lrrspector of Wires. Ii iSL; RAN CE COV Ei2.A.GEi Unless .vaived by d -.c o«%mer, no permit fur tete performance of electrical work- may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned ce:tisnes that such coverage is in force, and has exhibited Proof of carne to the permit issuing ollice- CHECK ONE: INSURANCE Ij BOND ❑ O -MER ❑' (Specify:) ,ty-t,� (Expiration Date) Es�irtnated . u,u2 ofEteclrirKi Work: .5-60- (When required by municipal policy.) Work to S?a;c;/ laspcctiors to be requested in accordance with MEC Rule 10, and upon completion. I certify, anelrr t&,eparftsrstrti pelralries ref pequry, that die information air this application is trite and complete. F1RI I NAr�XE: Acrel _E1 Licensee: Richard J. Arel Signature4 fzvz (If arplivabie, enter -e " vi r,rfle in a c :rjcer,sR rrurrrbe:• [tae) Address: 773 WaGhi ngt-nn 4traar OWNER'S iNSURANCE NVAIyER. I am at the Licensee dots required by icy rev signature below, i hereby waive this require nic.it. OiYttrr%i1a:•ttf Sig :ature Telephone N'a. LIC. I%iO.:-1723 -- LIC. NO- 27514E Dus. Tel: No.:,,_ 978-372-1601 Alt. Tel. No.:` M-302- 187 not have the liability insurance coverage norma; f! I am the (check one) ❑,l owner ❑ onner's agent. PlsR'.IIIT FEE: J 9610 L �w t Date .......9 — ......9' .A/. d .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........S%r-'.2 ... S.gr�l}?f S.G� r. .............................. has permission to perform ..R:1�.%L� ..... f�. ,k 9.4,:PW r,g A,�,df.?e,,,, wiring in the building of ..... ............................ at......9�.....a.I......T.............................. . North Andover, Mass. b Fee.. Lic. No. ..!:a`. 014 .................. �... ELE RICALINSPECTOR Check Ji�S_�—_ �\ CornmortureaGth o� ///a�sachu�ei� Official //Use Only cc�� cc77 Permit No. -{ S� gZ lug eLJePartmen� o�.}ire �erviees 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), 5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IN%ORM�4TION) Date: City or Town of: / Vc r��1 C�V-•P e To the Inspectd of ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) gel (,�o QSc Gc Owner or Tenant � _k j VXL P, �t`� ✓1'� x Telephone No. 5' - ' a. y, Owner's Address Y f o CA r L-1 Is this permit in conjunction with a building permit? Yes ❑ No ©� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity IV Location and Nature of Proposed Electrical Work: EZ- /',...,..t.,i;.,., — 1 f lid-ina table mm, he waived by the InSDector o1 rV fres. Attach as tional detail tf destred, or as require y t e -spec o 0 Estimated Value of Ele tncal Work: (When required by municipal policy.) Work to Start: C 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 cover m 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 ury, that the information on this application is true and complete. FIRM NAME: vl c VA /V1 LIC. NO.: � Licensee: Signature of LIC. NO.: (If applicable, enter "e empt" ip the lice a number line.) ,� Bus. Tel. No.-22�- Op -a,,& Address: S C-0 n 1 l— - . r J ' \ C% Alt. Tel. No.: �s1�3.— � W *Per M.G.L. c. 147, s. 57-61, security work requires partment 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 ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ `a-� Signature Telephone No. . ... No. of Total No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators �'A No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. ❑ No.of Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices HeaTou�mlp Number Tons KW No. of Self -Contained No. of Waste Disposers Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection El Other Heating Appliances KW Security Systems:* Equivalent No. of Dryers No. of Devices or No. of Water, 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 E uivalent OTHER: d b h 1 t r f Wires Attach as tional detail tf destred, or as require y t e -spec o 0 Estimated Value of Ele tncal Work: (When required by municipal policy.) Work to Start: C 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 cover m 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 ury, that the information on this application is true and complete. FIRM NAME: vl c VA /V1 LIC. NO.: � Licensee: Signature of LIC. NO.: (If applicable, enter "e empt" ip the lice a number line.) ,� Bus. Tel. No.-22�- Op -a,,& Address: S C-0 n 1 l— - . r J ' \ C% Alt. Tel. No.: �s1�3.— � W *Per M.G.L. c. 147, s. 57-61, security work requires partment 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 ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ `a-� Signature Telephone No. ."0077 Date ....... 5.:.,�".. ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........A/U.1-- has permission to perform ..... �c 9.'' 7fL.0' 7 ........................ wiring in the building of ..... 6kw7..... ,...... . TSA ..................................... A at ............4 Q2e J............5,�'.'.......... .... . North Andover, Mass. v 172 Fee �r�.:�....r...... Lic.No...........3. .� . .�..^J.............. . ELECCRICAL INSPEc5 Check #-�Z / IN Commonwealth of Massachusetts ()Ilieiatl (�Ise�(}'nl� V Permit No. / sC 2 7 R `17 _ Department of Fire Services --� Occupancy and fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9%0.5] (Ica�c hlanl:) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All %%ork to he performed in accordance x%ith the Massachusetts lilecirical Code (n9I{C). 5�)7 ('`9R 12.00 (I'LE.•I.SIi PRINT IN INK OR TYPEALL IrVIY)RAL9TIOtV) Date: Cite or Town of: ,ZV• y' -t- To rhe In.yec•lor off• I•i,'h•es: By this application the undersigned gives notice of his or her int n to perform the electrical work described below. Location (Street & Number) �J �%� QSSnOf Owner or Tenant Owner's .Address n Telephone No. Is this permit in conjunction with a building permit? Yes ❑t No ❑ (Check Appropriate Box) Purpose of Building_ ��q�,yAr�' Utility .Authorization No. Existing Service (QfYD Amps 120 / Volts Overhead L Undgrd ❑ New Service Amps / Volts Overhead ❑ 11ndgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: A�Gt 3 A716 A No. of Meters No. of Meters Completion of the %lloiu•ine fable nun• he haired hr flu, hunec•for of If'. 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 Alerting No. of Devices g No. of Waste Disposers Heat Pump Totals: umber, ITons.K� o. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating Kai` Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KNV Security Systems:" No. of bevices or Equivalent No. o aterK,,. Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiringg: No. of Devices or E uivalent OTHER: Iffach aclditional devil i% desires/ or as required ht• flit, Inshec•tor of f1' Estimated Value of EI ctrl al Work: Z", CSD (\\'hen required by municipal policy.) \fork to Start: �� ® � Inspections to be requested in accordance with \•IEC Rule 10, and upon completion. INSURANCE C' VERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unl the licensee provides proot'of liability insurance including "completed operation" coverage or its substantial equivalent. Th undersigned certifies that such coverage is in force. and has exhibited proofof same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties of perjurt•, that the information on this application is t ice and complete. FIRM NAME: Arel EJ Tric LIC. NO.: 17238A Licensee: Richard J. Are]. Signature LIC. NO.: 2751.41. flfoliplie•ahle. efier "erengi" in the license nnmher line.) Bus. Tel. No.:978-372—I(1,6j Address: 773 Washinpwp Stcee, Q I 83e .Alt. Tel. No.: A7R—'t(1) �jtj 'Security System Contractor License required for this work; rf applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee sloes not !tore the liability insurance coverage normal) required by law. By my signature below. I hereby waive this requirement. I am the (check one) ❑ owner _❑ owner's ag Own nt PERMIT FEE: S Signaturetura "Telephone No. 7765 Date..? ..'S..-.\ � ........ . TOWN OF NORTH ANDOVER PERMIT FOR CAS INSTALLATION 11 This certifies that ... JE -T-6 -„ .... . has permission for gas installation in the buildings of . L. k. V, , ; f ..................... at ...9. 6.. Q.x ?a ..15T......... , North And ve , Mass. Fee,3.15.•cao .. Lic. No. 1.5.2- 1 Z-.. �. . GAS INSPECTOR Check # 9 6 f -7 M%r I lm] ^ Xco W W z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: d/, AAA)d UL t' MA. Date: �9y/ Permit# C0 1.14 Building Location:- ! (D U� (� Owners Name: C AJA %2 / d /2 Type of Occupancy: Commercial 0-1 Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ v! New: ❑ Alteration: ❑ Renovation: ❑ Replacement: B--" Plans Submitted: Yes ❑ No ❑ M%r I lm] ^ Xco W W z C0 1.14 v! C6 m M I LI— O W O W W O N H = W Z F- O g Z m W W Q' 0a. W W N L lA U W W ~ q 0 W a0 W Q F=- Lu X = ti Z W W U) LUZ _J.1 Q H O = W O Z O~ H W H W O U s Q Q v_ 0 Q! W c9 x� g 'o a 9 W F->>>� Z Z 2 o SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR —dT'—FLOOR VH FLOOR 8 FLOOR Installing Company Name: C4" lfliAj Ac— t /17—/,Check One Only Certificate # —T i orporation Address:�/ ����J�UN( City/Town: N, [T/ `I b0L)rt2 Stater Business Tel: c/� 6 Vq V-3 ❑ Partnership Fax: Name Licensed Plumber/Gas '��F% ❑Firm/Company of Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes [J Ivo ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner E1 Agent El By checking this box ❑; 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and arrnroka fn ♦Le knc-F ..i..... v......a_.�__ __�.�_. _.. _.___-_.. - - -- ----- -- ---� --••_•••-`•.9" `•••" •••"• "•• Y'•'•^••�••y •YVIIL -- 'Ju I:ISLd110iwn5 perrOrMea unaerthe permit issued forthis aonlicatinn will ho in - -- •-•-•• •• • r.Inaaaavouseus mace rmmomg cope antl chapter 142 of the General Laws. Type of License: By E3 -Plumber Title ❑ Gas Fitter Signr #Pticensed lumber/Gas Fitter 2 -Master 1,16 City/Town ❑Journeyman License Number: ,s APPROVED OFFICE USE ONLY El LP Installer k A 9458 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that. LG v ................................................................................. i has permission to perform .... oo'l......Q.. t%7-60 - ............................... wiring in the building of ...64/n.4 ..... ............................................... at..q/V4� d dG[.S�— ................... . North Andover, Mass. i . %,r?... ........... ?1 /9' Fee..9: .......... Lic. No. ..7p , -!r! .............................................• ... ELECTRICAL INSPECTOR Check # Y/ 0-�� Commonwealth of Massachusetts OfTiicciiall Use Only Department of Fire Services Permit No. I it 3 CJS Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 617-116 _ City or Town of. /Uo bAae,1` To the Inspec or f Wires: By this application the undersigned gives notice of his or her intentio to perform the electrical work described below. Location (Street & Number) alp Q�}�1AO Owner or Tenant/h� �tSSO - 7 ; Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service W Amps /ZO / 7,p 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: �j� & /fie Zsd ma ll Aer*clei Fen Cmmnletinn nfthe fnllnwino tnhlo mini ha wni—d by tho Inenort— nfW;r No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Tota 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 o. o etection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eatumP Total um .er """ ons '' " .......... ""....... o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ElConneection ElOther No. of Dryers Heating Appliances KW SecuritySystems:* No. of Devices or Equivalent No. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications irmg: No. of Devices or Equivalent OTHER: Attach additional detail Ydesired, or as required by the Inspector of Wires. Estimated Value of Elec ical Work: e%sd (When required by municipal policy.) Work to Start: amo Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 17238A Licensee: Richard J. Arel Signature LIC. NO.: 27514E (/fapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 978-372-1601 Address: 773 Gia chin teA—Street ,—Ha-erLi I I MA 01819 Alt. Tel. No.: A7R-309-91 R7 -- *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's Yent. Owner/Agent ' Signature Telephone No. PERMIT FEE. $� _ 6/2/2010 12:04 PM FROM: Foster TO: 1-978-688-9542 PAGE: 002 OF 003 AC RD. CERTIFICATE OF LIABILITY INSURANCE os�o/2 0) PRODUCER (978) 686-2266 NO. ANDOVER INSURANCE AGENCY INC M.J. FOSTER INSURANCE SERVICES 163 MAIN STREET NORTH ANDOVER Mh 01845-2415 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Arel Electric, Inc. 773 Washington Street Haverhill MA 01830— INSURER A: HANOVER INSURANCE CO INSURER B: INSURER C: INSURER D: INSURER E: VVYQnftVW THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. INSR LTR OD'L NSRD TYPE OF INSURANCE POLICY NUMBER POLICY (MMIDDIM IVE PSAUTE ION (M IMID�OIV)) LIMITS A X GENERAL LIABILITY ODN8148943 03/06/2010 03/06/2011 EACH OCCURRENCE $ 1,000,000 ERENTED o� 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES r nce $ MED EXP (Any oneperson) $ 5,000 CLAIMS MADE QOCCUR / / / / PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PR - POLICY ,CT LOC X SE A X AUTOMOSILELtABILrtY ADN8748653 04/11/2010 04/11/2011 COMBINED SINGLE LIMIT $ 500,000 (Ea accident) ANY AUTO BODILY INJURY $ ALL OWNED AUTOS / / / / person) X SCHEDULED AUTOS(Per BODILY INJURY $ X HIREDAUTOS / / / / X NON-0VWED AUTOS (Per accident) PROPERTY DAMAGE $ (Pei aoddem) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC $ ANY AUTO / / / / AUTO ONLY: AGG $ A X EXCESWMBRELLA LIABILITY UHNS156729 03/06/2010 03/06/2011 EACH OCCURRENCE $ 1,000,000 $ 1,000,000 X OCCUR OCLAIMSMADEAGGREGATE S DEDUCTIBLE RETENTION $$ A WORKERS COMPENSATION AND WHN8751259 03/06/2010 03/06/2011 j[ TO y'TATI - OTR - E.L. EACH ACCIDENT $ 500,000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? / / / / E.L. DISEASE -EA EMPLOYEE$ 5500,000 If yes, describe under SPECIAL PROVISIONS beim E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS eeomaceTE HOLDER CANCELLATION { ) r - (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT TOWN OF NORTH ANDOVER FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MND UPON THE BLECITRICAI, INSPECTOR OFFICE IPRURE ITS AGENTS OR REPRESENTATIVES. AUTHORIZ®REPRESENTATIVE 1600 OSGOOD STREET NORTH ANDOVER MA 01845- �Jh ACORD 25 (2001/08) ®ACORD CORPORATION 7888 INS025 (oioe).os Page 1 of 2 ....... /xf TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ '4. ...... Lv —'� /— -. / ........................................... P has permission to perform ......3' .... C, ........... .................................. '/// ........................ wiring in the building of ...... ( .......... I at ............... 15 .... .............. -North Andover, Mass. —A Fee.....=ic. 910� We L ................. ie'. 11 FLE661CAL INSPECTOR I i Check # 74 9071 Ell lrom wnwea& of i/lamac/zacseffs Official 2eearfinenf of} cc�� c�ire Services Permit No. / z2 7f 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), .27 CMR 12.00 ,r (PLEASE PRINT IN INK OR TYPE ALL INF RMA}'TIOA9 Date: a / dXG City or Town of: ��el� Z�w, To the Inspect r Wires: ed gi By this application the undersigned notice of his or hpr intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant �� �,.�q R 1 C �Se ►^– AA r . Telephone No. 2 -;6 -tea –C)Va Owner's Address Q4 `r �--i,, Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Existing Service New Service Utility Authorization No. Amps / Volts Overhead ❑ Undgrd ❑ Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cr; vdv' i� q No. of Meters No. of Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El-N-o—.ol nd. nd Emergency Lighting BafteEy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ......................................................... Tons KW No. of Self-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances ICS' Security Systems:* No. of Devices or Equivalent No. of Water, Heaters No. of No. of Si s Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value f er,,i�cal Work: (When required by municipal policy.) Work to Start: C/ Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE C VERAGE: 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 coveis in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE B eOND ❑ OTHER ❑ (Specify:) I certify, under the pain and p nalties ofperjury, that the information on this application is true and complete. FIRM NAME: rskl,kJ j LIC. NO.:jC Licensee: V d �}h . Signature PJ, LIC. NO.: (If applicable, en r " mpt"irl the license numbe line.) Bus. Tel. No.: S' 30� Address: '� M1. 4k i C b'\- -0 V�N 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'sent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Pl Id y IAl. .41 t .a�;�� �. � m\ 0,1 ©a W f' Mg �"RI, v '�a r• t . , L 1 �. 6, f A V � i qy� y TOWN F z ! FPIN 55 TV IA06s. WAA, sit. AW, A At W Date ...... .7.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING /�/..C-/-- Z--Lt'-7- Thiscertifies that ............................................................................................. has permission to perform wiring in the building of ...... ................................... at .... S .` . ......................... North Andover, Mass. ==.���� . , Fee.. ................... Li c. Nol7 ......... ............ ELECTRICALIINSPECM Check # PE r t..teryn�csso rarsafdls v r'Ja3ls fiae3tEf# S3ificMJ L'sc �y BOARD OF FIRE PREVENTION KEOLiLAPONS �i�ell a :,nc�.alxi Fee Chec%ed Melt 111991 I (leave Fslanlr� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK flti tivicerk to 6c prsfo :txd in accoidmwc with uir Ma=chuscas 0=trical C'ulc r tf" ? C�IK 12.00t , �2. (PL,CAS, ?RIMT I Y ; V OR TYPE' A' l�YF0P-Xf.-t7i�1e1r) I��tc. �j p City or Town or. TJ tiie LrsE1e for t�j Wires: BY this application the uneaersigtie,', givcS clothe atlas or her insertion to peri'.jrm the electrical work described below. Loc2tiu22 (Street turniter) ("Q to N. 4 N4 Owner or T'ennaut 1, Telephone No. Owner's Address - Is this permit iII ctfljuuctio 3vl 12 a builfiing permit? -Yes�� —_ (Check Appropriate Bax) i'urlinse of iiuiltlit:g --htLA D Utility Authorization No. Existinly Service �v v Amps U / Volts Overheat.' -- e{t. Sen•ise Antps t Volts Ovencczd lNuttnber Of Feeders and Ampacity Location and Nature of Proposed EIec:trical work. I r I;... C' . L -4, Undgrd Q I'o. of Meters - I Und-grd Q NO. of Meters Mw No. of Recessed Fixtures . No. or Lighting Cutlets Zana reiiaet c{ Ine -oralaw-V QTc. of Ce2'l.-Susp- (Paddl � Fans No. of Hot Tubs tff�fe hazy be waired by dw hip' _cion or ires. I NO. D ota 'frstlsforlllers Crne,rators Iti"1"A No. of Lighting Fixtures Swinunilag Pool Fe In- rnd.rrd. 0 o. o. mergency Lighting Battery Units iiia. of Receptacle: Outlets S tNo. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 1M. of teras Burners I o, 01 MeteCtIOU an inifiatinz Devices No. of Rnages `Patz No. or Conti_ Toas iso- of Alerting Devices -No. of waste Disposers eaTerL^w i ua2 er osss h�Y iia o entalit DetectionlAlertin4 Devices _ I No. of Disltivasllers �Space!Area Hear ng H1YLacal Q Municipal Connection Other o. of Dryers INo. of t ter ftentzrs k -NV Heating AppliancesI{w ' z<_ a Baiiasts SecuritySystems: . No. ofL'exices or Equivalent Data Wiring. j No. of Devices or EAquivulent No. Hi-droulassage Bathtubs i`lc. otiliotors Total 1<iF % t l c ecommunicatlons Firing: { No. of Devices or E uivalent ) OTHER: ,R,)�sr �l�i 1 .tttaech addition a[ detzi; if d aired, or as rers<ireei 3y afre losnec., r of :Y:res_ INSURA0CE COV ERACEs Unless :vaive:d by the ou--her, no pe rruit fa.- the per:ormance ofelectrical {work may issue unless the licensee prov;des proof of liability irsursnec mcluding "completed operation" coverage, or its substantial equivalent. The undersigned ce:tii'aees that such coverage is in force, and has eeiubited proofofsame to the permit issuing office. CHECK ONE: INSURANCE Rl BOND D a1-mR 0- (Specify:) (Expiration Date) Estitnaated ' aiue of ':c. ice.; I Fork: (When required by municipal policy.) Work to Start. Inspections to be requested in accorJance wide IMEC Rule 10, and upon completion. I certify, Itchier t rep ins andpe rattles a,''pedury, Aitrt tkr W-Orntadeft On tltis application is trite and complete. FILUNI?tiANIE: Are1 r" LIC. I�0.:�723 Licensee: Richard J. Arel Signature LIC. \O.- 27514E Afaziphwbie, enter-ewnrp. - al me !ic im number fine) BUS. Tel- No.y 978-372-1601 Address: , ,Alt. Tel. N*.:�- M-302 .,?187 OWNER'S i`SURA iCE %VAIVEtL- I ant aware tlmdors.n t the Licceis ot have the liability insurance coverage normls required by la- By i ny signature below, I hereby waive this requirement. i am the (cixck onc) o owner Ell owner's a sent. Owner/Agent Signatune _ Telephone IN,:) P.GIi'tlI1T rEE: $ V m m m VI m m 1-6 C) y CO) C13 C d 1CD O a Z O CD O 'v ar c � � c d =� 'D C7 O v CD CD O Q CD CD O CD w oo C O CA CD d O y CO CD � v CO) O 'v Z CD n ,R OCD O CD O G1: C7 a o X: 3o C �� O N 2 z ►� C y O Q E. N C x O I It =O :5.0 a® O 10 m W n tTj n CO C1 d C, � Z CD E� �CD o C3 m a?m m ,,. H c CA CD -1O 2 > > -0 C C07 1C �• p O H C7 CD CD C H . 11, co CL O =r CD CD o f t my m CD �••p� , :!^ N CL N Cr C N C''• :Q ?ca CO) CD G1 N 3 � CD � o cn o O zZa �Q C-)= C CD V I co Cao,, C, CD m' .a CAnom: o: CD CD sem. 3o o o n 7d o 7 O C x a rn o b O z ►� G- C x O I It tTj CA tz E� C3 �J rA I y 0 0 c w' June 29, 2009 MACLAREN ASSOCIATES INC. Mr. Gerald A. Brown Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Certificate of Compliance Affidavit for China Blossom Restaurant - 946 Osgood Street Permit # 526 Issued on 04-07-09 Dear Mr. Brown, This letter shall serve to confirm that Maclaren Associates Inc. has performed the necessary site inspection for the project referenced above and find it essentially installed in accordance with our plans and specifications and to the best of our knowledge and belief are in compliance with the applicable regulations and requirements of the Massachusetts State Building Code. Inc. Nammour, AIA Principal Regist& License f 41, .11170 R%Da,A, ti ri The above 1V appeared before me on the date written below and m de oath that the above statement by him is true and he is authorized to make it. Subscribed and sworn to before me this A!J day of 200.9 Notary Public Marianne BraWCommis l Expires suesnyaassulN to 1411sSAWowwoo Notary Public tg0z'9i. ludy sealdx3 uolsslwwoo AVy My Commission Expires April 18, 2014 oil�ind tiB;oN Commonwealth e,`;��assi�zru st�ii* ' �tpiaj euueusyy 3 Main Street, Andover, MA 01810 TEL. (978) 4700700 FAX(978)4700709 E -Mail Mac.laren@verizon.net 0 Date ....... .:. ..... ."-....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING C This certifies that , _.• ..................... ................................ has permission to perform .....!t�r: �'.'.......-_. � :.: --*�:^-1...... ` .Ar.� wiring in the building of J ' :............................: ^ ............. at 2%l".......... .�f'•r � = .......................... . North Andover, Mass. Fee—;,�?x .. ....... Li No':U Y..? .............................................. -! .... .... ELECTRICAL INSPECTO/R / Check # �'� ! l/ / 8 55/ 0 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.- eWJ 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked i [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 INIIVK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER S� 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) 9 /Ica ri.ti / Owner or Tenant /V f_ o 1 Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes No ❑ Purpose of Building(Check Appropriate Boa) _ �>Li�y�^ Utility Authorization No. Existing Service d� �+'-a Amps X20 / �G� Volts OverheadUnd rd g ❑ No. of Meters _L New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: i 07, 'J" o e 100A_ _ T /� Lid-f�.Sla._ ^I S h .1� S h 'd e of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers Heaters KW No. Hydromassage Bathtubs OTHER: Com letion of the No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool �d e ❑ Igra No. of OiJ Bu_rn—nr-s No. of Gas Burners No. of Air Cond. Total Tons Heat Pump INumber Tons —11 offals: Space/Area Heating KW Heating Appliances K, No. of No. of Signs Ballasts . table may be waived by the jLranstormers KVA Generators KVA o, o mergency ig ng Ba7t�te Units Fli�J L lA to . v `moi'- r'�a Nc -.i mines o. of Alerting Devices Detection/Alerting Devices Local ❑ Municipal Cnnnerfinn ❑Other oocuriLy systems: No. of Devices Data Wiring: No. of Devices No. of Motors Total HP Telecommunications No. of Devices or Wires. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Ae (When required by municipal poIicy.) 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 E� BOND ❑ OTHER ❑ (Specify:) & w i + 4.Ict .tiAlxy I certify, under thPf ains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: E LIC. NO.: Licensee: . Signature (If applicable, enter "exem t " in the license number line.) LIC. NO.: Address: — 5,� —Lra c� �t� �( Z7�! Bus. Tel. No.:�L� 7, 9�7 � lT�r c/ 7 *Per M.G.L c 147, s. 57-6 1, security work requires Department of Public Safety "S" License: Alt TelLicNo No.:ffP 1 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. $,--2--;7 i I t www_mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers oDlicant lnfnrrnatir.n Name (Business/Orgwization/Individual): Addr6ss: 1. t c . VN *Any'- City/State/Zip: The Commonwealth of tblassachuselts y k- ! I' Department of Industrial Accidents Office of Investigations �IZZp Are you an employer? Cireek.the appropriate box: is , 600 Nrirshington Street Type of project (required): Boston, MA 02111 I t www_mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers oDlicant lnfnrrnatir.n Name (Business/Orgwization/Individual): Addr6ss: 1. t c . VN *Any'- City/State/Zip: Phone #:..�4•-4� y —02,77J70 �IZZp Are you an employer? Cireek.the appropriate box: L. ®. I atLt a employer with �_ 4, ❑ I am 8 general contractor and I Type of project (required): employees (full and/or part-time).* 2. ❑ I am a.sole proprietor or have hired the sub -contractors listed New construction � partner- ship and have no employees on the attached sheet. t These sub -contractors have .❑ Remodeling 8. ❑ Demolition working forme .in any capacity. [No workers com . insurance ' P workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition required.] 3. ❑ I am a homeowner doing officers have exercised their 10.❑ Electrical repairs or additions all work [No•workers' comp. right of exemption per MGL c. 1.52, § 1(4), and we have no 11.❑ Plumbing repairs or additionsmyself. insurance required.] t q ] .employees. [No workers' 12•0 Roof repairs comp. insurance required..] 13-M Other "Any applicam that checkshoz'#1 ms' o t ust also fill out the section below showing their workeeompensation 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. $—Mttacwrs that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' c`n , ..,. ra5an. lam an employer that is.providing:workers' compensation insurance for ray employees: Below u the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address:__ C[ a% _1. T Attach s copy of the workers City/State/Zip policy declaration page (showing the policy number and expiration date( I 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 of perjury that the information provided above is true and coned rte% /l - ✓d=. Phone #: ficial 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): f 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical 6.Other Inspector S. Plumbing Inspector 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.ite 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' eornpensation 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, notthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the numberlisted below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom • of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investitrations 600 Washington Street ' Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MA.SSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia MACLAREN ASSOCIATES INC. June 29, 2009 Mr. Gerald A. Brown Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Certificate of Compliance Affidavit for China Blossom Restaurant - 946 Osgood Street Permit # 526 Issued on 04-07-09 Dear Mr. Brown, This letter shall serve to confirm that Maclaren Associates Inc. has performed the necessary site inspection for the project referenced above and find it essentially installed in accordance with our plans and specifications and to the best of our knowledge and belief are in compliance with the applicable regulations and requirements of the Massachusetts State Building Code. Maclaren Associates Inc. George J. Nammour, AIA Principal Commonwealth of Massachusetts Registered Architect License No. 11170 The above known to me appeared before me on the date written below and made oath that the above statement by him is true and he is authorized to make it. Subscribed and sworn to before me this day of 2007. Notary Public My Commission Expires 20 3 Main Street, Andover, MA 01810 TEL. (978) 4700700 FAX(978)4700709 E -Mail Mac.laren@verizon.net Date. JORT 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �,SSACNUSi This certifies that ............ has permission to perform7.�'_ ....................... plumbing in the buildings of . ................................ at . Andover, Mass. ....... ... . .... North Fe....... ...... Fee ...... .. Lic. No ....... - .6 .; ......... Check # /�� 00�� I / PLUIVIB?P�tG INSPECTOR L MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS ! 6 Date Building Location Owners Nam Permit # ' Amount a Type of Occupancy New ri Renovation Replacement15/ Plans Submitted Yes No 01 mi it u ' i i il►/ ----.-------------------- .-----.--------..------WM (Print or type) Installing Company Name o Address Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: —'�p M 44 y —1,4 '/ Insurance Coverage: Indicate theme type of insurante coverage by checking the appropriate box: Liability insurance policy IZI Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance 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 perfor ermit for this application will be in compliance with all pertinent provisions of the Massachusetts State umb' Code an Chapter e General Laws. By: Signature or Licenseciu er Type of PI tubing Li Title �y% City/Town icense um er Master Journeyman ❑ APPROVED (OFFICE USE ONLY uuu 311, 5 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Nrizshington Street Boston, MA 02111 t i www_mussgov/dia . aWorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nlicant Tnfnr..►0+;-n Name (Business/prgmization/Individu 7o A1114 Address: /3 City/,State/Zip: Phone #: . Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: l C7 Job Site Address; City/state/Zip: Attach a copy of the workers' compensation policy declaration Faitpage (showing the policy number and expiration dale}, . 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 c� pains nd penalties a er rP l that the information provided ab w is &"f and correct Phone #: ' 7— �ciat use only. Do not write in this area, to be comp,&,ed by city or town off 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.Otber Contact Person: Phone #: Are you an employer? Check the appropriate box: I. ❑ I tim a employer with 4. ❑ I am a gametal contractor and I Type of protect (requires: — eliiployees (full and/or part-time).* have hired the sub -contractors 6 New coristrvction 2• am.asecle proprietor or partner- listed on the attached sheet. _ � ❑ Remodeling ship and have no employees These suit -contractors have 8. ❑ Demolition working for me in any capacity. [No workers comp. insurance ' P workers' comp. insurance. 5. ❑ We are a corporation and its 9• Building addition required.] 3. ❑ I am a homeowner doing officers have exercised their 10.0 Electrical repairs or additions all work myself [No•workers' comp, right of exemption per MGL c. 152, § 1(4), and we have no 11.F] PIumbing repairs or additions insurance required.) t 'employees. [No workers' 12.[] Roof repairs comp, irisurance required.] 2 3.❑ .Other *Any applicant that checks boat# l mutt also fill out the suction below showing their workers' compensation t homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors - lcnntractors that check this box policy information saffiii must submit a new affidavit indicating af. ouch. must atohed an additional sheetshowing. the name of the suircontractors and their workers' i po. ^ infomtatior.. I ani an employer that is.protrrdfrtg:workers'compensation insurancefor niy. en;ployem Below is Me Policy and job site . information. ,. 9 A /l/ _ .. // Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: l C7 Job Site Address; City/state/Zip: Attach a copy of the workers' compensation policy declaration Faitpage (showing the policy number and expiration dale}, . 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 c� pains nd penalties a er rP l that the information provided ab w is &"f and correct Phone #: ' 7— �ciat use only. Do not write in this area, to be comp,&,ed by city or town off 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.Otber Contact Person: Phone #: Information a nd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of 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 includirig the legal representatives of a deceased employer, or the me receiver or trustee of an individual, partnership, associatioin or other legal entity, employing employees. 'However the owner -of a dwelling house having not more than three apa-tments 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 t3he 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 coritracting authority." Applicants Please fill out the workers' compensation• affidavit complertely, 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 require& 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, notthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers` compensation policy, please -call the Department at the number listed below, Self inaimrr3 mimn5m;o-c ahnitin_' smtpr fhf-.ir self-insurance license number on tiae'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 A -ill 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 officiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-727-4900 ext 406 or 1-8.77-MA.SSAFE Fax # 617-727-7744 Revised 5-26-05 www.rnass.gov/dia IN 0 TOWN OF NORTH ANDOVER o PERMIT FOR GAS INSTALLATION This certifies that ...... ........... ....... ..... has permission for gas installation in the buildings of ... ............ at r"4 North Andover, Mass. Fee;ol/ 7 071' /..r. .... Lic. No ............ (//-�-GASIK NSVIR- Check # / "� A6 6793 0 n MASSACHUsurs UNiFoRMAPPLICA MN FOR PERM ToDpGASRrnNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Z 6 Building Loqations Gtzp 0. , Owner's ame New ❑ Renovation ❑ Replacement Permit # Amount $ Plans Submitted ❑ " (Pr'nt or type) C'neck one: Certificate Installing Company Address ( / �� ❑Corp. . Q ❑ Partner. usiness TeTeep5one ❑ Firm/Co. Name of.Licensed Plumber'or Gas Fitter-� INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent Check o Yes If you have checked Yes, please 'ndicate the type coverage by checking the appropriate bo Liability insurance 0;; ,4, No❑ p �' Other type of indemnity ❑ ❑ Bond Owner's Insurance Waiver: l,am aware that the licensee does ndoes °-fie the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this.pennit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner I hereby certify that all of the detailAgent s and information I have submitted (or entered) in 0 application a and best of my knowledge and that all plumbing work and installations performed under P accurate to compliance with all pertinent provisions of the Massachusetts S it Issued for this application will e in the as and Chapter 2 of the General Laws. City/Town, APPROVED (oFncE USE ONLY) ❑S'gnat1ie'OST —Licensed Plumber Or Gas -Fitter Plumber 5Z7 Gas Fitter License umber Master ❑ Journeyman �� W � G H ZW1 C W VO m x W) z d x z w F c a z W .7 5U B -BASEM ENT p'�. L + G U < O u p B A S E M ENT 1ST. FLOOR 2ND. FLOOR / 3RD. FLOOR 4TH. FLOOR J TH. FLOOR 6TH. FLOOR 7TH, FLOOR. 8TH. FLOOR. (Pr'nt or type) C'neck one: Certificate Installing Company Address ( / �� ❑Corp. . Q ❑ Partner. usiness TeTeep5one ❑ Firm/Co. Name of.Licensed Plumber'or Gas Fitter-� INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent Check o Yes If you have checked Yes, please 'ndicate the type coverage by checking the appropriate bo Liability insurance 0;; ,4, No❑ p �' Other type of indemnity ❑ ❑ Bond Owner's Insurance Waiver: l,am aware that the licensee does ndoes °-fie the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this.pennit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner I hereby certify that all of the detailAgent s and information I have submitted (or entered) in 0 application a and best of my knowledge and that all plumbing work and installations performed under P accurate to compliance with all pertinent provisions of the Massachusetts S it Issued for this application will e in the as and Chapter 2 of the General Laws. City/Town, APPROVED (oFncE USE ONLY) ❑S'gnat1ie'OST —Licensed Plumber Or Gas -Fitter Plumber 5Z7 Gas Fitter License umber Master ❑ Journeyman �� J •IKi .�, VT j.1 41 L r ;- tie uomrrnonwealth of Massachusetts Department of Industrial s4ecidents. Off1ce ofIMes-ations huz 600 Was,Qton Street �osfon, 11�q 62111 k'"yu'-mass.gor1dia Workers' Compensation Insurance .Affidavit. Builders/Contractors/Electricia 3Iicanf Information ../Plumbers aIIle (Business/OrganizationMdivi dual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: ❑ I an a employer with 4. ❑ I am a ---- L_ neral contra -Mor and I have hired the sub -contractors fisted ant the attached sheet t These sub -contractors have workers' comp. insurance. ❑ We are .a corporation and .its Office -Ts have exercised. their right of exemption Per MGL c. IS2, § 1, (4) and we have no employees. [No workers' comp in employees (full and/or part-time).* 2 ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required_] • ❑ I am a homeowner doing all work myself. [No. workers' comp. insurance required.] t Type of project (required): — .6. ❑ New construction 7• ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10:❑ Electrical repairs or additions l 1.❑ Plumbing repairs or additions 12=❑'Roof repairs 1 " ym' appiieant.that checks box # 1 .must also�fill out the section below sho Since required.] I 3 ❑Other + ? iomcowners who submit.tltis e�udavit indicating• iiiey a= owing their workers' compensation poLc� mm�hon. 1Conaaeton fhai eheaf: this bos.must wiFe=• e ` tv n. rt,�t Enrn hire outs arched an additional sheet showing the cuntraeiurs "flat su'omii n new name of the stab-cr,tors and trt u atntinvit mc:cati::g .H. Pullcy irtforrnaflotL J •••••` wy,Uvuldrto wor�e"S' M.��atiort Lnsurance.for"9' empLopees. Below, . ^,rP fiq, tndjob o t is the policy' and job site Insurance Company Name: Policy 4 or Self .ins. Lica. #: Expiration Date: Sob Sitr Address: Attach a copy of the workers' compensation policy declaration Q City/St&-/Zip: Failure to secure coverage as required under Section 25A of pane (Showing the policy number and expiration date). fine up to 51,500.00 and/or One -Yew imprisonment, MGL c. I52 can lead to the imposition of criminal penalties of a Y as well as civil penalties in the form of a STOP WORK ORDER and a fine In es to .1250.00 a day against the ante or. Be advised that a copy of this.statement mai be forwarded to the Investigations of the DIA for insurance cOve age verification. Office of I do '4PP-411) -W4, .. Pucr4� arta ppnn/tics ofperjur;' rAX the information provided above is true and correct Official use nnly. Do not write in Gds areal to be completes' by city or town official City or Town: IssuingAuthority (circle one): Pet�nrtlt-iceRse # L Board of Health 2. Building Department 3. City/Tovvn 6. Other Clerk 4. Electrical Inspector S. Plum btrtb Inspector Contact Person: Phone iniormanon 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. asevery 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 includieng the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, associati on 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 m.int.-nance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall nat because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state a r local licensing agency shall withhold the issuance or renewal of a iieense or permitTto operate a basins 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 acyntracting authority," Applicants Please fill out the workers' compensation affidavit comps-etely, by checking the boxes that apply to yotur situation and, if necessary, supply sub -contractors) name(s), address(es) and phone nurnber(s) along with their c—ertificate(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 affil-a.vit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the -affidavit. Thtaffidavitshouid be returned to the city or gown that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you.have any questions rag'�rdirg the iamo, or if you are required to obtain a work"�rs' compensation policy; please call the Department at the nn_anbor.listzd below. Self insured co,�,pa,iies si►oiild 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 l of the affidavit foryou to fill but in the event the Office of Investigations has to contact you regarding the appii=L p Please be sure to fill in the p--mri license number which Will be used as a reference number. In addition, an applicant that mist submit multiple peimit/iicense applications in arty given year, need. only submit one affidavit indicating current policy information (if necessary) and under "Job Site Adds-ess" 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 Iicerises. A new affidavit must be filled out each year. Vrhere a home owner or citizen is obtaining a iicensl� or permit not reisted to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of investigations would like to.thank you in advance for your cooperation and should you have any questions, . please do not hesitate to give us a can. The Departm ent's address, telephone and fay, number. The Commonwealth Df Massachusetts Department Oflrmdmtrial Accidents Office of ravestigatiogs 600 WaShdngton Strict Boston, MA 62111 Tel. # 617-727-4900 =rt 406 or 1-9—/ 7 MASS AFE Revised $-26=Q5 Fax # 61 7-727-7749 wwW-Mass.gov/dia / 9- 0 Date. ry ......... . ?�.,<� •�,;:_��ao� TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING • Y i o � SSACHUSE� This certifies that ........................................... has permission to perform .................... . plumbing in the buildings of .. r: '/zc"�".'.. �............ -� . . at . 1. 16 .. _ ......... ,North Andover, Mass. Feel%C+ ..... Lic. 'No...a..... �//� (, ++ P6UVBING INSPECTOR Check # -�' m rd {" J MASSACHUSETTS UNIFORM ,APPLICATION FOR PERMIT TO DO PLUMg.ING (Type or print) NORTH ANDOVER MASSACHUSETTS Building of New El Renovation F—I Replacement Installing Company Name Date -��G. ( P Permit # Amount Plans Submitted yes No F1 Check one: Certificate Corp. Partner. Frrm/Co. Name of Licensed Plumber. ��Q 1 :Laurance Coverage: Indicate the type of ins a coverage by c ecking the appropriate box: tI.iabiIity insurance policy u Other of in tyP� �ty Bond insurance Waiver. I, the undersigned, have been made aware that the licensee o Ej three insurance f this application does not have any one of the above signature EDOwner submi Agent I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and installations tted (or enured) m above application are true and accurate to the compliance with all pertinent provisions of the Massach Perf°rm d uPermit Issued for this application will be in By Cnderode d Chapter 142 of the General Laws. 71,enawre m 1 'Title / Type of Plumbing License City/Town APPRO1-rcense Mrn )er Master. VED co�cE:USEot�t..Y journeyman 0 I he c.ommanwealth of Massachusetts Department o Ind 1 /Jd 1 ustrial Accidents . F . Office of Investigations 600 an,Qion Street BOStO n, 1VL4 02111 Workers' Compensation insurance .A•$icFay.I�t. guhd� /Contracti:ors/Eleetri ' Ar, Iicant Information czsns/P}umbers Pease Print Lemb}v Name (Business/Organization/Individual): Q ( '�� Address: 3 City/State/Zip:�G/%�1ti Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a o _ Type of Project (required): m to tes full and/or -Part-time).* have hired the sub-conotractorsl P Y�� ( p ) 6. ❑New construction 1 am a sole proprietor or partner- listed oo the attached sheet t 7• ship and have no employees These sibcom-contractors have El RemodeIing working for me in any capacity, workers'insurance.8 ❑ DemoIition [No workers' comp. insurance 5. ❑ We are a p corporation and its 9. ❑Building addition required] afncers 3. I am a homeowner doing all work right of have exercised -their 10:0 Electrical repairs or additions ❑ mvself. [No. workers' comp. c 152 exemption Per MGL I I.7 Plumbing repairs or additions insurance required.] t errs la' e 1 �4), and we have no P Y s [No workers 12'❑ Roof repairs comp, insurance required.] 1.3•❑ Other t lion cownerstwlio sub"] Jhic a,i davit indicaso eiug L` eut e- �cno `Ebei�owtshowie.rtg th-ir workers' comperssation pofic} information. 7Conttactors that check this box must attached an additional sheat showing &"u to -n hi M outside eomraciom must suomii a non, am¢avit indite rt s ch. the name of the s•,:b-cc-,Mors and thair won=' -MP, I am an emnlover that i� providing workers' contperrsation iKsu policy inrorsnation. information. rance for IT, employees. Below is the Polk:, ¢ndjob site Insurance Company Name: Policy # or Self -.ins. Lic. #: Expiration Date: Job Site Address: City/State/Zi 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 crimina] enalties of a fine up to 51,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORT: ORDER of up to .S250.00 a day against the violator. Be advised that a cop} of this statement may and a fine Investigations of.the DIA for insurance coverage verification. ) be forwarded to the Office of I do hereb , J the p pnnlfias o f perlurJ' that the information provided abov is true and correct SiQrrature: _ Date: O Phone #: / ,�! 1 Official use onlp. Do not write in than area, to be completed bT city or town of- ciaL City or Town: Issuiaae Author' Y (circle one): PermitJLicense;r I. Board of Health 2. Building Department 3. City/Tovvn Clerk 4. Electrical Inspector S. Plumbirto 6. Other a Inspector Contact Person: Phone ; O LS LO eLu ` aanopue }ewes uieua g yvu `aanopuy UPON IGGAIS poo6s0 9ti6■ saauueld s}oa}!uo.Je r�:b4;9 INvbi 1d1S3u WOSSO"IS VNIHO � d -oul sele!oossv u8jejoew :Sa; /O/aD :ayJ of suoilejeliv Pesodoad :,,e(o,d'ON sulmeAa I r 0 0 0 0 0 0 0 0 0 /3 8 U w� loo O EV U 4 w WJ� W I L ---------- I I I I I I I I I 8 ole V Z r v / X w Z g 0 0 J LL U) � o J u Q ! H T w QJ ^ Q C L U) z ------- U --- I I I I I I I I I I I I I I I I OD = I I I I I I I I I I I 8 z I I I I I z I I I U I U I s I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 8 ole V Z r v / X w Z g 0 0 J LL U) � o J u Q ! H T w QJ ^ Q C L U) 0LSLO eua ' aanopue }aaals u!eiu g MAEAS8g -yyy 'aanopud 4PON "180-49 POOBSO 9V6 �'� 8 saauueid s1oa;!yoae "1MdunvjLs3w YYOSSO'ia VNIHO z d •oul sojeioossty ua.aeioew 6002/20/00 6ow;�SzS :Saga .Aaa :ay; 01 suo!leaallb� Pasodoad :,oa(cJd 'ON eu,MeJa ---------------- 41 ---- ---. W N W I m 3 °D N m i o I l a I I w z coi w �''7 o I I af" d v O 23 3 < I 1 < p I ¢ a m a z z Q s I I41 w rn Ix I i z < ¢ 3 o o I�I I N z zd � I I So � U. CL / I I d ¢ 4S kJ $m �� d o n-� / �\ I I �' m o m om c�i <oaQa > �z�+ \�.\ S / I LL m z N_ w N X W N3¢ � �m oxo / \\�� I O j l 3 mg 7d' W 9 �' wo Q Qv3 x¢ WNL / �� I I o _ p h z� / \ 3 z U y K m z 1 o�a� 3Q �� // j�� _ o �N w z=maz S ; ¢ Z S 3d 0 rn ofo ¢�Ktia 3m �mg �� I CL �4' 3 0 CL P vi En Q O = W 8 Z 41 W. p. O V Z N H F N J // V y N _$ .. / \ I Q 3 P, In z'¢Q p oQzo�amaao�3 // o@ m / I r%i zy �ia Nz i� a zd5o�s�ozs/ c as Q din =3 La pw a siif p a�mc�imk-"ayw / 'moo Bim Q m 'O I I � NR ?Soso r-r� U In / $ o o t1 z I / I ¢ ¢ K W 3 � Z O N 3clU hf .f U'i / lLU d- I O f W ?� OS= / ND W� O I / I Io Bil= cs5� W O �.N,1 0 / W N 'N y O) N I H V7 ¢¢ = i zz K� / ial-% 3 Q v ml c m I Y ca a j� Wm a �N �K / HY y °6 00 d m >�I / o $m y m I F ai ¢ U¢ �C'i o / 'x o o= ro o O o I / m u c 5 LL> o' I 3 W 9 w 3 %'� �n Kwa J�J / LL) a° ¢° rn mzl / -L Qyo Ew I WzFzd m pafn m¢¢ co� m u� wl / d@ omU mW �O �Q¢cQ¢o�o�F c, oao �Z� ui N 4/ �oc j _ �w� �I z�3 i W �o�o6m9: Ei a w MCL m¢wmma ¢far¢-UWa�WQ' / .•.i.: alcn- J I o I p KaaaFw OZOQ WQ K m c I Ell/n fV wK r'i .f vim vim O F N Z a V w � cr K ((({AAAJ W U R H CL J f a Q z a 3 S wz d W O N N z r CL ¢o m z w dV) via U W Z a W - cr ��adm�o CL C', z�vyiff6- �nz wa" ZOO z m m N Q W5 Q Z� O Z 3 N W 5 La W Q Z Da UNC� mao0Jv,wQ Qw Y � Z d Q a gz� W g22�55 H LU W p w ���Z��z K g Q O W S Tis ,d�pOCaU' 0' __? Us d d? 3 W Q KW O p K in � N cV Mi a vi cp 1� ' I 3o�m i ----- oz F¢ Z f K N O� z RZ l /\ I O ¢< a= I I n 0 As V, ZK z N U g O ,. p = Ww LL U _ Za o z a o a z r -K m / m uss� fw OOH w Ca y � K �r- z Z - ________________ � VZi W V O U DLn J a m o N 3 V / > Z 3 w 3 w 3 z i p V w 5=0 �QS ix mSo�a=m yo �j?a K X .-ami ¢ ciIEri f¢avi x ��� O®U 3:/ "'zd�c�Kmm Z i mao $ z¢cJ Y m a z I I �--- ------------- F m F- o iS z -- - ------ - ----- ------- m o Q � ¢, m a F o a I ash LLE z m Y j woKv�oSBQ I I toWo m�OQoa Y�i�Z I` C - <m�myN Ka mets I - I$I 3o P W w �^ 3s�aX<g�z�"m I o � a oXdQ3omxUoo W mom apo a� 3 I I �� si Fr U CL U F -Ujj d' ELM. Mw3 3=N]w][[oY_ I y}! iris x yapui 3 FWBw.-W Z W, 6 Q¢Z N I �f y �ptlM(mo f"¢< 5 z"� Oj 25 1M4¢ 8 N O SpZZNZWZZCW,Id UO WZWWW YUV ¢ a O O D D z W I x •mccm N ~ tl yS I Z w d 3 M0900o2�o¢ma W? W KOC' K Cr W W W I IO Z d 2 rA I z m p W Z K C m f f C K K K K ; Z(q_ I Z 4� Ln �gc.iMvvi orad -oi�� I I ---- o C v vim O F N Z a V w � cr K ((({AAAJ W U R H CL J f a Q z a 3 S wz d W O N N z r CL ¢o m z w dV) via U W Z a W - cr ��adm�o CL C', z�vyiff6- �nz wa" ZOO z m m N Q W5 Q Z� O Z 3 N W 5 La W Q Z Da UNC� mao0Jv,wQ Qw Y � Z d Q a gz� W g22�55 H LU W p w ���Z��z K g Q O W S Tis ,d�pOCaU' 0' __? Us d d? 3 W Q KW O p K in � N cV Mi a vi cp 1� ' I t i i ----- RON -----�dT= - - -I O dal vya -c mid yJ z�I Ko II O II d la Rn�sdc� � O� 1 I �F ----------- I* _ _ - - - _ _ - - _ , I I I I i I I I I I I I I I I I I z - a � � a� Hos _ h IW Z J PS F z �z m Wz U K Q Q Z X N �V) W � LLJ w *f N 3 y Q o Zo R = = Q Z 0 -';;cc Z U Q 3 BsFQW3 W � W 0 (n W W O o W S d? �Qzir< C) K a f U N c4 ri 4 8 'a zza N i K Q co I6 i ----- oz F¢ Z f K N O� z RZ l /\ I O O W a= I I n 0 As V, ZK z N U g O ~N p = Ww IJ U _ Za o z a o a z ----------- I* _ _ - - - _ _ - - _ , I I I I i I I I I I I I I I I I I z - a � � a� Hos _ h IW Z J PS F z �z m Wz U K Q Q Z X N �V) W � LLJ w *f N 3 y Q o Zo R = = Q Z 0 -';;cc Z U Q 3 BsFQW3 W � W 0 (n W W O o W S d? �Qzir< C) K a f U N c4 ri 4 8 'a zza N i K Q co Z � d oz F¢ Z f K N z O W Z W 0 As V, ZK z N U g O C7 Z W O p = Ww �9 U _ Za o z a o a z uss� fw OOH w Ca y � K �r- z Z N 41\w � VZi W V O U DLn J j p = 3 U 3¢ r7 3wt~n N 3 zzx''z w z w 3 w 3 y p V w 5=0 �QS ix mSo�a=m yo �j?a K X .-ami ¢ ciIEri f¢avi 0 0 CL0 CL I g CL CE 0 0 LLJ A W 1 LU 3 w = w y Z W z o Q o vi a w J [-i 3 00 om k' < m m 1U X <a ® v W W U ¢ 9 a ? a a .a S z �' w � oho Q ¢ z < �Zb < Z I y x V- <w O Cd Z m Wa 3 zm< O m3 7i F� W a o O x zz=w U ui W E5 Nz O Oa U N m< O F ri w < W a H 2 N U Q N x Q W Es 6FZomaz3z ° !L ypZ %< O W d' W Z o O O< D H Q O Z to Oo F538� w �� N '� F W K V O= U1 O w O W N ks In LD a R 3-- 8 = 0 o<m ��§ma Z a C-) a= te; 3 x R W� N m (+ W W z R W a a S o z 3 z N z W? ' a ai'ozom��i� o5; S5017iWp S 1.3.1ao K W W W Z I m ma O- 2OC �w W r � �SNwi4wi6�cd.06cs vi U Z CL m F ¢ 0 ' w W OU N /_______ _________ F� I z N F U< I I 0 vi I I W m � a I I a m N W W LLJI I N d o m x = I I ¢ ¢ w z I I d v w k' ' a I I .0 3 z W Q LLJ® / � I S y 7 z wQ / ��\ I d mN Q a oW U z / �\ I J om / I o U. I L U W N N� I F I z m' o w o n m / �� i o > W m m Q a> mz����� m I W zaN N 1 O W= // I \\ I 5 3 m Nz 48 z Q 3U �N= i; �mg // ° m m / I M z ¢m oda N= i43IL r= '" z �:�N / .0 �IL ma 3 ;�:0 �� �/ I W wi rlJ � J Date... :...... ........ �J WORTH pf ,.•° ,°,ti0 r TOWN OF NORTH ANDOVER O 9 PERMIT FOR GAS INSTALLATION This certifies that ......_. "�-...... . j C� has permission for gas installation % -5�-^�- - �..:.: - ...... . in the buildings of ................. :... .:...--:....... . at .. v ... :.. �;� :. ��(... ! ........... , North Andover, Mass. Fee....... Lic. No.�� .� 7�. ��..,.1C,r....... GAS INSPECTOR Check a t 6755 MASSACHUSETTS UNiFoRM APPLICATON FOR PERMTT'TO DO GAS Fn,EIN (Type or print) Date % NORTH ANDOVER, MASSACHUSETTS Building Loqations Owner's Name New ❑ Renovation Replacement d G UB-BASEM ENT ASEM ENT ► ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. .FLOOR BT H. FLOOR Plans Submitted 0 ' Name of Licensed Plumber'or Gas Fitter t4 n„ /,/ -7- Check one: Certificate Installing Company 0 Corp. rlPartner. 11 Firm/Co. ,jT1N COVERAGE I have a current liability insurance, policy or it's substantial equivalent Check onYes . If you have checked Les, please i dicate the type coverage by checking the appropriate box y Liability insurance policy O4. NoO er type of Indemnity D Bond 1 Owner's Insurance Waiver. I am aware that the licensee does not the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: er i hereby certify that all of the details and information 1 have submiOtted (or ee r in 1 applicatioAgent ns 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 Massachusetts( and C .142 of the General Laws. �7 _31Ye-�License� bei Or G� Fitter Title Plumber y?� City/Town, as Fitter icense um er Master 70 4PPR6VED (OFFICE USE ONLY) Journeyman 'a U w C9 0 a w o U z ddF o cc > Q 0 a� w c � _ � � a � o F o z w .� c Name of Licensed Plumber'or Gas Fitter t4 n„ /,/ -7- Check one: Certificate Installing Company 0 Corp. rlPartner. 11 Firm/Co. ,jT1N COVERAGE I have a current liability insurance, policy or it's substantial equivalent Check onYes . If you have checked Les, please i dicate the type coverage by checking the appropriate box y Liability insurance policy O4. NoO er type of Indemnity D Bond 1 Owner's Insurance Waiver. I am aware that the licensee does not the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: er i hereby certify that all of the details and information 1 have submiOtted (or ee r in 1 applicatioAgent ns 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 Massachusetts( and C .142 of the General Laws. �7 _31Ye-�License� bei Or G� Fitter Title Plumber y?� City/Town, as Fitter icense um er Master 70 4PPR6VED (OFFICE USE ONLY) Journeyman 'a Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ...... t L...... :.F r— .4 ............... has permission to perform .......... ...... ........... wiring in the building of .......x !v—.. ss.' ort� ............................ at ....... /z .......... .......... _S7 . . ..... North Andover, Mass. 17 Z3 Fee..................... Lic. No. ..... ...... A.aq ............ ELEc-rRicAL INsPICTOT Check #2 71-1 8070 �arruxonrc4atLh o� lf(assa iitc�d� ©�ci: i t:sc O>ziv Permit y� 1Japarfrrxa,:.l a�.rire �srfica3 � i\p_ BOARD OF FIRE PREVENTION REs�t 1�,Tir,�lvS1 `'ccun,�ney arxi Fee Clleeiced i�{2ev. i I/99J ttcave bt k4 an APPLICATION FOR PERMIT TO PERFORM ELECTRICAL, WORK All work to be performed irr accordairce with die M,, 1,usctts Ell.'ctfic., Cock ;ltiti C), g 7 tf{ i2.�fl (PL -r"SE PPvNT hV IINK OR TYPO AILrL I1Yi'ORAL4T10iV) Datc: Q� City or Town of: TO the Inspect , aj Wires: BY this application b"e utu?ersigned gives +tohce 01 tris or her itxen¢non W pc;form die electrical work described below. Loca(iun (Street S N'ul;ll)cr) q --161")T<1__^/ .-u Owner or Tenant Owner's Address Is this permit Ill coilluticti n. with a building Pcrrnil? es Purliose or Builclit• Telephone jNo. - No M (Clieck Appropriate Box) •g E #3tility Asthori7ation No. Existing Set vice Antos dP f QY 1"atts Overhead � Undgrd Nect•_Ser�• " Atnps f Volts Overlicad�-� t__: Undgrti Number of Feeders and Anipacity Location and Mature of Propos et� Electrical Worn: NU. of illeters IYn. of Meters• - um rrrrorr ct ure No. of Recessed Fixtures i-01—Igtube Play be waired by die lits' cctor of i`r`ires. No. of Ceil: Susp. (Paddle, F2115 t o. o 1 ota !'rasssformcrs KVA Generators KVA t o. o. mergcticy Ig hang - No. of Liglhting Outlets No. of Hot Tubs !No. of Lichth:g FixturesS►rituttlillg Pool Ir`- rntl, Battery Units No. of Receptacle Outlets INo. of Oil Burners FIRE ALA.%,vlS i,To. of Zones No. of Switches 1IND. of cas B iurners o. o Detection and Initiating Devices \o, of Ranges N'a. of Air Conal. Tans* leo. of Alerting Devices �o. of Waste Disposers eat unlp i eltn er sns h V� Totals: i o. o e! alltatne _ Detection/Alea ting Devices No. of Disin-vashers -------- -= tSpaceL4rea Heating MVLocal h unicipa - Connection Other s No. of Dryers Heating Appliances K ;i• Securityvstenis- . N - of ;iter "- o No. of De„zc_ es or Equivalent [ ...0�� t 4. Of Data Wirina: 1leatc!rs KAV Sins _ Ballasts 1a of Devices or Equivalent No. Hy dron=ssage Batloubs l�e:ontnitln catsons Miring: No. of 1%lotors Total! 11F' l No. of Devices or Equivalent OTHER: ��_ Attach additional detail if desires', or as required by the inspector of Wires. INSMkI i CE COVEIZr10E: Unless :N -aired by the o«rler, 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 ce.-tiites that such coverage is in force, and has exhibited proof of sante to the permit Issuing office. CHECK ONE: INSURANCE 13OND D OTHER C (Specify:) ' Estitliated slug of Electrical Work:7 (Expiration Date) (When required by municipal policy.) 4Vork to Start: Inspections to be requested in accordance with MEC Ruie 10, and upon completion. I cortify, an tier the piths turd penafdes arperjurY, tlittt the itrfa>rination on this application u trite aitd cow et . 1FI1Q*1 NAME:: Anel Elertric,LIC. h0.:-I72.3U Licensee: Richard J. Arel * Signature LIC. NO.: 27514E (Ifapplicabie, et:tar '"exemp."in the!icenrenjunberfine.) flus. Tei.1o.• 978-372-1601 Address:_ ____=3 WL9hjngtnn Street urr� a rhi 11 MA til Rii-/ 1i2� AX Tel. No, _�'78-3Q2_�187 O f NER'S i tiS URANCE WAIVER. w I am aare that the Licensee dors trot have the IiabiIity itisuratzce coy erase normal required by In v. By znv signature below,11 hereby waive this requirelne.-t. I am the (check one) Q owner Cj ov.=Cs agent. OwnerlAbent i Signature Tricpllonc Na_ Pt;R1lIIT t'L•£: $ L rl ,R Location C71760 (gsboo �) No. A Date r HQRTq TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Nus <� Building/Frame Permit Fee $ 'i Foundation Permit Fee $ + Other Permit Fee SlIP'S $ -� TOTAL $ Check # Building Inspector k OR 0 a CL c� 0 0 } y C 0 AO 0 �• 0 hy• o z o �-► 0 y�1dv�N` a^ r a 0 Q y Z Ir 0 1 y Aix C A& SS OOt its C 0 r� All A A • � O � O Q.: o o' 0 CA CA a r d d CD o N (gyp 0 CPD 12 OR 0 a CL c� 0 0 } 4 y O O * Tow �Q 0 y�1dv�N` a^ r a 0 Q y Z Ir 0 1 y Aix C A& SS OOt its C 4 p y 1.0 �04. z d O I o p y O O Oil ** row y y n ' t o is A o • • .� ? Asa S+ **44 Ott its d O C p CD W a t0 N O O D z n 3 r m 4 D T T E: A O z r r O O m 0 m m O m N z DJ N 0 co c� 3 0 'a 0 Ci cD cr N R P. Co. cc O C m 3- _ cc v v C cr O a a 0 ani as Q N z 0 PA 00(nC)?.v D -w M O rt O m o m 0— N fl1ca N(n 'C7 V1 f N to o C: O M n o -a cD3 S, .a icon= -0C o _ O79 '0— a:3 o 3 ry, mc, voa CD O,A� o vV CD ,Q cD a C 0 (C (D 0) (0 -, ? Us �• (O cj a o (O -D (6D Q) cr � (OCD N' CL CD -, -1 . « a 0 0cD _ r'�a9CD CD N c to N ui 0 O 3 C 0 (D = co CD CD a== 0 N Q n N _ m Cc) 0 CL o(Q '<0 (D 0 CD MD3(Q�c cD N a co co N 0 .a 0 co 0 Q n 0 0 m 0 0 CD CD CL O v Q- M (D (D N CD 3 po r vo CL v cr w O iu -ODS (D N :EO 0 (CD CD ;Or �_� S,000 0 0 ..0 N=•' 3 to o C: m C -•. Ej' G (Dr, N Cn (D N = CLCL G icon= -0C s' _ O79 '0— a:3 o 3 ry, CD O,A� o vV CD ,Q cD a C 0 -v n' 0 _ Y 1 Im N -q z �' z MO 3 z 700 D M _ r D n z v O O < Z rn o CD ��,U 3�M 0-0z 3 (D N :EO 0 0 US1 3 0 -0 0 0 ..0 N=•' 3 o cr s% �•Qw co N r+N � (Dr, N Cn (D N CL cn �' CD N icon= -0C s' _ O79 '0— a:3 o 3 ry, O O 0-0• 0 .-: a-, p- -1 9 @ O,A� o vV CD ,Q cD a C 0 (C (D 0) (0 -, ? Q '+ M' C N 0 :7 (D 3 CD 0 Cr ::9 D] J- (D cD o (O -D (6D Q) cr � (OCD N' CL CD -, -1 . « a 0cD _ r'�a9CD CD N c to N ui 0 O 3 C 0 (D = co CD CD a== 0 N Q n N _ m Cc) 0 CL o(Q '<0 (D 0 MD3(Q�c cnm 0 -v n' 0 _ Y 1 Im N -q z �' z MO 3 z 700 D M _ r D n z v O O < Z rn cn o 0 R 0 o cr s% m � m0z CL cn CD N (O s' w 3 C o �CD . CL ':k CD ,Q cD a C Zj 0 -v n' 0 _ Y 1 Im N -q z �' z MO 3 z 700 D M _ r D n z v O O < Z rn z 0 3 -v r m 4 m D T .0 E: D O z r r z O OD m D n m m v CD cn z w (CD 0 cQ CD O 0 5. Q. (D o- r: m c v 0 p C 9 000OK-u rn0cD0 CD . O -,CD O cp M. cn CL c- h 3 inn 0m a N c 0 —' s CD m CL cn co O N :3 Q. O v (D (D v 5 cn cQ' cn CB*�,�m�0 D 0 O =• c O m =3-0 CD o -o o co � -v (D;:;: 3m=r@ a (D -p 0- Q n) z O cD 3 @0 vi o o �O``� cn cn � - 5 � -v �� �~ • m CL v Si 3 3 3 Cn CCD 1 o �.CD OywCL CD � 3C: OL I cnp-9m 7 O ,C d N 4 �• O O m m O o WR c CA ':/3 =r c-` CD 0 O m •DH T CD N• CL m O. am=3(D3=rm :3 CD— oma cn-+ O c O O 3. O m (CD cc -11^►m CD 0-0)�.� �n 0 o 0 CD �3�w �cc �'ma � m 3 w 0 .c O cn (D CL 0 0 Pi 0o r- co O� n 2 M.(a zcn D o M 3 O z (D;:;: CD D 'a O D O �O``� z v ❑ �� �~ • I+CL CL v Si 0 m . r: CD N OL I � `- ((D LV a r� CD Or) ca G1 z -4 0 .Z M 3 O z U) (D D -a D 'a O 0 r nCD z v ❑ z rn � v Si CD Or) �1 unshine /Q p sign company, inc. 121�w.��t6oro road `—.north_grafton ma 01536 8.839.5588 fax 5 39.9929 email garyc@sunshine-sign.com jv,%ww.sunshinesign.com rerm y`it §pecialist roiect Manager SUNSHINE SIGN COMPANY, INC. ARCHITECTURAL FABRICATORS COMMERCIAL ELECTRICAL SIGNAGE ADA & WAYFINDING SPECIALISTS UL MANUFACTURING FACILITY COMMERCIAL PROPERTY SIGNAGE PROGRAMS FLEET GRAPHICS FACILITIES LIGHTING MAINTENANCE SERVICES CRANE SERVICES CNC ROUTER CUTTING SERVICES REGULATORY & SAFETY COMPLAINT 7; unshine sign company, Inc. To: Bob Nicetta Building Department 400 Osgood Street North Andover, MA 01845 Phone: (978) 688-9545 Fax: (978) 688-9542 From: Sunshine Sign Company Gary Cunningham Phone: (508) 839-5588 Fax: (508) 839-9929 Subject: China Blossom Bob, I have enclosed applications with revised sign dimensions for your consideration. The raised aluminum letters "China Blossom" and background now measure: 2'4" x 15'2". "Restaurant" and "Lounge" and background now measure a combined: 1'5" x 59'7 3/a". The entire install- ation cost will be $4360.00. Thank you Gary Cunningham �+ I t : ► �''"`'' �....,� .0 (� r C Qi O Cf) F. O CD w U Cf) U Lo Ue 00 v w -jcd 5 C m O U Cly Cn cn CXR CD cam/) c1-0 cn �- LO cn �- M oN ,-- il CD ccd Q CD < CD cz �. m cm � X CD CT � E CT .0 � F— m _ Cl) Cly U C O U En cn O O Cn O O O W C _ Q cn •«-- CX) to CY) d. , II CU � II cz • cz U C Q Q1 C/3 C O c .O W C O cmnC CD E 1� w12, C3 2 LLJ o � LLJ YLU LLJ c� uj CD Z m CD vii o m w cC.aanrzLLJ CDm Q?..-jm Ia ,... A Date ..:*/a TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 5 's1SSAC MUSEtS �cl a1� This certifies that .... ......... dd has permission for g/aj installation ; � in tl/euild/ijng�s of at f' ... (:`!�!: .: �.f �... , North Andover, Mass. Fee GAS INSPECTOR UJ Check # �1 MASSACHUSETTS UNIFORM APPLICATION (Print or Type) NO d MWWOL, _, Mass. Date Building FOR PERMIT TO DO GASFITTING _ 14--202.!�Permit 0 Owner's Name GY..A , ,d ,en Type of Occupancy CM4AMot0b1.1ii4IL . New ❑ Renovation ❑ A acement X Plans Submitted: Yes ❑ No IV Check one: Certificate # Corporation lcg2 ' ❑ Partnership Business Telephone 81749 Oft C- 7-g9 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter.... - INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have c hacked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ r norouy wrmy mar to or the oetaiis ano information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent. provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title Plumber i 1 Gasfitter Gty/1'own Master APPROVED (OFFICE USE ONLY) 4.1 Journeyman k Signature of Licensed Plumber or Gas Fitter License Number MENEM EMEMMMMEME ME NEON MMMMEMMEME ON MEN OMEN EMMEMMEM MEMO MEMEMIMMMEM MEMO M Check one: Certificate # Corporation lcg2 ' ❑ Partnership Business Telephone 81749 Oft C- 7-g9 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter.... - INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have c hacked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ r norouy wrmy mar to or the oetaiis ano information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent. provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title Plumber i 1 Gasfitter Gty/1'own Master APPROVED (OFFICE USE ONLY) 4.1 Journeyman k Signature of Licensed Plumber or Gas Fitter License Number a f Date. ` HORTh I Of<� •�,;•�tioL e, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............. .. . has permission to perform plum in in t e buildings'of. .� at .... %!...til. (.`....../ (� 7 ,North ndovfer, Mass: Fee ..... Lic. No. ....1. !.. P 1-�-29 PLUMBING INSPECTOR'Check # MASSACHUSETTS UNIFORKAPPLICATION FOR PERMIT TO. DO PLUMBING (Print «Type)'r - r 4 L" 'o Mass. Date Permit # Building Location Owner's Name_iril� ItLN F�D�S<JY11 i�4u Type of Occupancy, (-t/V1�MTru.lyljlt . >F , Repla Plans Submitted: 'YeNNew ❑ Renovation o FDCiES z � < • Q z N < rC Q _ O z 4 z UJ Q W z Z J N W a! = Q t` W N Y C <=< 3 X o z o z W C <. W 2 C < of = Q G lC Q W W W i 3' J N C. Q J C C c L. tz W x 1 x a 3:1 o z x Y d O M- < Y < ut Y, X W h- V> r o =. n. H F. = O o. a� z Z .W O V S atic -1 m a at a 31= r<-. 'A &6 v n< 3¢ m O SUR—B S MT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR -, STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name_ - , Orir�rn_ec I Business Telephone= Name. of Licensed Plumber 4 INISURANCE COVERAGE: gave a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142: Yes P6 No ❑ If you have cbecked Yes, please indicate tie type coverage by checking the appropriate box A liability. insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: -I am aware that the licensee does not have the insurance coverage regdkid— by Chapter 142 of the Mass. General laws. and that my signature on this permit application waives this requirement. Check one: Chimer ❑ Agent ❑ Signature of Owner or Owner's Agent t 1 hereby certify thatail 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 p�darrned under the permit issued for this application will be in compliance with. all pertinent provisions of the Massachusetts State Plumbin 'Code and Chapter 142 of the General' Laws. BY. Ng—nature of licensed Plumber .: 'gas Type of License: Master Journeyman O C)ty/Town lv . . IC NL License Number ! Date. 4v- TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that f�°'.'� ... ... .. ........ . has permission to perform_.--.,-., ............. : .-... ......�. plumbing in the buildings of at .... , North Andover, Mass. �. Fee....... Li. No.......... Pl BI G INSPECTOR Check # 6413 1 rAr MASSACHUSETTS UNIFORM APPLICA (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location of New 1:3 Renovation Replacement N FOR PERMIT TO DO PLUMBING Date Permit Amount titer Plans Submitted Yes 11 No (Print or type)+ Check one: Certificate Installing Company Name (W1*C %J1 utb,nl& + ftsm&& R Corp. flop 9 El Partner. nn -- 0 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate t ke type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the un rsigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 1:1 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 Massachusetts �bi Code anter 142 of the General Laws. BY Sign' aatur� ice'L eU r um�Jer Type of Plumbing License Title City/Town icense INUMDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY CA m m m CO) CO) F) _ polF CD O °D _ CO) CD 0 7 w d d 0 _ Cie F3 0 CA W -A c� CD O _ CD / CO)� CD CO) 0 CCD O CD c =r -,O O1 2 S d! O Q NO F O.0CA N o M o Cc) C'! m�ao m Z O gr y� � = m oy-' m oFn- =r �odfC � N ?m: m = O m O O C) p N' C09 W=r O O F� c. 3 CA : CL VrJ m m H VI m ^ C7 -o :� a m a, a► 1„ O H :F d N cn— .n '�Cco �.s e e^► .yrt O . N ems' (""� cn H '� = : N is S CD 40 O O "O'� G �P c cn 0 CD:� o c CD CD o � . Jd .. h Mu m cn _ o tA o o a o Y ^� Oil o z % t r� M F 10 OWO �O '50 1� FRAME: Fireblock - over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters - watch bearing at walls. Ridge & Hip - Provide proper connections. n 0 GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway 1 �4 6 Continuous strip footings for interior columns 7 FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations % " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. % of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing.. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure. G' i Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and heal support. Joist hangers - fully nailed w/ hanger nails. Sill plates 2-2X6 (1 PT) w/sill seal. Girls - solid brick or steel plate bearing at foundations % " air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances - stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0" clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. % of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36 " high, Baluster max space 5" on center. Over 8' above grade, use 6x6 posts w/lateral bracing.. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re -inspection fee - $30.00 (Be Ready). Certificate of occupancy required prior to occupying structure. LtIC UUIVlLYIULv rrctla n time Lr tIJLVIt,nvJLsI 10 DEPARTAffiVrOFPUBUCS4FETY Permit No. ✓ 7 Z 7� BOARDOFFMPREVEMONRF.GUTAHONSR7CMR 12W Occupancy & Fees Checked r APPLICAHON FOR PE Aff TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street S Owner or Tenant To the Inspector of Wires: Owner's Address Is this permit in conjunction with a building permit: Yes o No (Check Appropriate Box) Purpose of Building Existing Service AmpsVolts New Service Amps�Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. Overhead Underground Overhead Underground Q No. of Meters No. of Meters No. of Lighting Outlets No. of Hot T No. of Transforms Total KVA No. of Lighting Fixtures 0050Mming Pool Above 0 Below Generators KVA round and No. of Receptacle Outlets e000, No. of Oil Burners No. of Emergency ting ttery Units No. of Switch Outlets .101, No. of Gas Bu S No. of Zones No. of Ranges No. of AirTotal -91 Tons No. of ction and 00.0 of Disposals No. of I Heat J Total Total Pum s Tons KW Ini'a Devicee of oundingo. No. of Dishwashers ace Are eating KW of Self C AQ Detectio ounding Devices Loc Municipal _ Othe No. of Dryers eating Devices Connections No. of Water Heaters KW No. of f Signs lra-AMk. No. Hydro Massage Tubs No. Or-TIs tw HP LOAF bizar=Coverage. PUtsuat*bdiV,aSSaCtI>9CtlSLien®lla IhmeaamatUabt3tyh>matce inciftcornplele YES NO Ihavesubrrimrivalidpioafofsanelo YES ffyouhaiedrdaEdYFS,pkmmdc* leNxcf ovmFby beoc INSURANCEBOND (P1e�eSpec�y) Estirn*dVakcofEkc tical Wdk $ Woklostat IrspecZ;cnD&R�gs d RaFinal SignedurlderTiel&lakJesofpetjay. IIRMNAME Lix=Ntz Lio�sae SigrEw Liaa>seNo Tel. No. r^ -'41m Alt Tel Na e r.OCSINSURANCEWAIVER;IamawaethattheLioawdoesnothavethemmarlmt�aFailsfilariale# alaitasre#WbyMassadmmsGeneralLaws and that my sgrtaalre on ft pewit applla6at waives & regtwarlaL (Please check one) Owner M Agent Telephone No. PERMIT FEE $ signature of Owner Of Agent ,R805`,�' vC, C= 4264- J)ISAIM Ream, 001.1 w7 Al wood.. 6,5? k, - 3-Z - S /v " PERMIT NO.: UNIT NO.:_ REMARKS: t o Town of ' NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT —PROJECT:- ""4' INSPECTION DATE: FLOOR: WING: BUILDING NO.: d -P, J!5�� 40-� /-7(- Excavation - depth and soil conditions Framing - Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains - Insulation - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Date: Date: Inspector Inspector Inspector Electrical - final Plumbing and/or gas - final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept - oil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: —Cof 0# Inspector Inspector Inspector ro— R� Acuon rrew, wo-iuuu 4 / .z_ . c•, ,'tartrr.-+¢:. aj .i�1ra-..�ar:ic:s:.r + - �� ..-----------_._ —._ BOARD C f- �_�� 'r.�}�r.. t`.:�''-:t1(tl =? •a '7-}!'� � ; �+C.:Ll;;n4`� 4!'tla i -,-s, {..17P—:Ce � ... '' API -11 ICATION FOR PERNAI i TO PERS ORPA ELECTI ICAL WORK wt�v k to be , .r{hr t,cu to ej{ 111Z� 'Wit t;7r. M ,. , r,. 1�' Jt.'_f: lais:. `Ri:_5::i� �.. �t:ctri ai �.. LR •' `vi 7' 1J S. it -_Q 'L" L',iT`.1..1,'� City s;t : _� L'.L'1r°. J_9 (;It$ !top +..3tS4^ ;.ii�'1ilGCr -? - � 2 or'j rTtE'S: i la: e 14'C^:l�C/iti C }liS of }7C:' e:711M.Uo:l ':? pCr: iSi l !I:C .Cr: t' 1Ca f i4" G?5CI11 P.'.1 ' oc liiutt (:r:.4r t & ilur:tlz ).-- r o"ivw. y�j}�[ phnr<e 2 i4. i) srer''s 15 this pC!Illii 111 Coli',U11Cii;J[1 ,Vit,,? :1 J}SilUi,ati }"<< ``j .._Y4S} r-' � I Lei {C 1C1'k. ril;prri2)r: lit' Box) Purpose of i3+ti; itl� t,"tz• alllwri - "St1G12No, :CISt1il', Set vicc C ,\t!:i;c q? t f , 1 -__... ---t-/.-C `-�t---!' CIIS -..lL!1� liiF'ii:i. Allips Ovenc�C!: 7i i -.- —_ LtiLt�a rt. iY:ii,:.;Jec- c;>• F;�eJers au+.l :�mgasity 1,c:atiutl at'.�°s YatUT2 of Proposed UO-Jricai Work: C ._�, !1 / . •-�.�111.7GL� ' ��_4 — . � �JLfi�l'_'_ __ _ Ii In r• N : VL_ /16 � `vr>r;cr'�ort L'a rail: ;,a'fu �r- 1`i4. of R cesscri Fixtures �INr,. of CHI.-SUsp.. (Paddle) E-ays i` " n be x-ai red s irr tlOro�i%'int A is •v. +:1 114;..za,g F,.tUlw-,5 �(Vr]_ 01 Uot, I U05 --+--'------- CS !� t; , , a7'0Ve r—: tl;. — '11"_],_11ilI toolUnits —C L3 .�v—t vc11_r ghi1i� mero r ,2 ' j Batten � tG. of _ N�, . 4f 0i: Burners IRE A�.a� � IN � S ZofICS �— iv. — t .� ,_ j{F . 4f y IN an, o lletectic-.l arld ;�. �asBurner-,—___ � _ St• 1:11i1a:1R$ Dev1Ci5 tU. of C �- :NG. Ur Aar Collo.. t <t;is Ili , +1 \�i` - i\' es ,. �. of AiertillQ )serif- I T :lTwil e:lt4sun*1 unlv—er 3_nS �I�G`•i:s)5: _ iYo. �CSL.11 oazaillcd :3 C'}GCtio11%r�IP.Ti?11^ DQYit�YS _ � i113ir:1Ua1 L Cil � lS..� Other _ ., •1.. «— iSpo ,A ea Heating )y; � — 1,'o. of Drver:i Ilieaf{`.i4 Appliances s 7 carlty Systems:No. orp.�,.,Jces or Equivale J' lz�- �' iri 14n. of _ Win. a 'Data ! --M�—�r iciearin.tini�at14i1S1�irinc: Yi alli?tit)J I�iG.01AIGOIr$ �1Sf:2ice.' l f �• !4, o, Devices al i0,TT`iEii: L..—__..--....._.._. __......._�_._._._..._._.—i'raci; add i:j : cst,-krd _'C:S )'C:j_!'1'r,a 7Y iha i:lJrle"CIC' /'r)}:. usJ INSURA,`!c: E C'OVE10.43E: [,mess .vaived b•i the owi:er, ilv,perrnlit i thl: pefi, l'Z7^ Ce afelCG : 1i 1'dpiC nia, issue lbe iicznsee Prov:eks rrooh of ii:ibility insura:7cC lnc:ludting "Co,1'.Jleted +? rr_C1C;1' ro•:erai>e or i;S Sll'lS:andai 'he 4 undersigned ce:i::es it:at such cc%-erno'.: is ih fi)rcz, wd has e::i`,IrA`s i >iCUI Ot sarne to the peri"rit :rSUing off -i C'. -'t-Ir::{=r:t':ti;: i`::;LP.'::vr 5 i ) r?a';Q Ca'lfE� ;S�ccifY:) "ir(LiirC ` L•;i e ? :e�iti'.�; 14`c1ik: l C (?( �_�� Mien -C!•!it;,. -y 1T.11l.i pai Policy i qG.. Lw: < xc--'.ica;s :c be r,: uested i aCCnr'vfan,:.!' vvid; !MEC l u: e_ :!�, :.:i 4 ll,on rpr;iGjZti.om `rt`lI', P.'It{1)�i'.(I�rIC.S O�ri7Cfjidfj•7l lli: the iflr±.`;fi; (.Td�D11 cif d115 f711117I1Cat7Uii ix fn'te aad cUt'1Pr'Iete. 1 - � —Ar el _E.Jec.Ly LQ_,Tnr�--�-__ 4_ LxC . itiO.: 1723,SA L ccu.scc: _ Richard J. Arel Si [tat lre itt`�t � (r _ LIC —,,N0.: 27514E �• ,- ., e. i'us.._�L 1''14.: �7�?,-37%— f7pl Address: _�3 t1gt n S1-r,pi— aLerli111, _ ` '—� Ale. TeL ;No.:_C3 j k.�' �:tiSull" .NCE.•V','.0 r, t:: ? Y rc �� t;� r' 's r^ t3-302- 187 r . a tl::zc :Cc t o, lb;iity irs.. ;c squl; a ,Ll =r v ;Fa: a! t ' ait'r• iillS yF%rt 1 L:a, i a' t o17C) G QtV TiCr �� own" ,s L' - L 10 l c w y TOWN OF NORTH ANDOVER .�_.•.'• °oma PERMIT FOR PLUMBING M This certifies that ... Ll A I.'. . . P .�.. �I.. 1-. ( `./......... . has permission to perform ..... S. ! ."...�.. .�'.l I .............. plumbing in the buildings of .. f,��.�.�.... .. .�.� J. !. --.... . at ... �7 �. �... � .S j. `... ...t.............. . North Andover, Mass. Fee. ?..... Lic. No.. �. )...... ....... u. � <......... t PLUMBING INSPECTOR Check # 6;41.2 MASSACHUSETTS UNIFORM APPLICATION FOR -PERMIT TO DO PLUMBING (Print or Type) p leo. �/l/�fDll�l2i , Mass. Date F&A % 20�_ Permit # Gd' Y Building LocationWI D Owner's Name_ iiti ►►( ��r75Sovyl Type of Occupancy_ LQ)vVl{N� t I y� New Renovation ❑ Replacement Plans Submitted: Yes ❑ No� FI TURES r CFIA/FR 4t Installing Company Name 11A-417 Add Z Check one: Certificate N(. Corporation `&f)OJ 10-6 v 4tit d. C2���S Business Telephone ! ) A • i) C- U7j C� ❑ Partnership Name of Licensed Plumber or Gas Fitter�gEj% �f~�Q/�[}��-j[� ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes X No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. T A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER:: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) In above application are true andaccurate 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 provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Title B y Signature of Licensed Plumber City/Town APPROVED (OFFICE USE ONLY) Type of Licenser aster ❑Journeyman License Number._ vu i •t. x Z Y Z �j LI) In z J Q } O U Q Z z Z > of W w O '' � w m w (/) _ toLf) u_ Z Ln z z a a U W z Ll W 'rU w r ¢ H to z_ a J (D Z . O L I- 2 U¢_ �O_ _� �w = M1 O a Q z = = cn � i- J Y z to . n- O f- cn z z< 0 Q' U o Y (�, w g¢ m z0 o o ¢ i o< o¢ 0 m o 0 SUB-BSMT BASEMENT e:E-- 1ST FLOOR z 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR I 8TH FLOOR I I Installing Company Name 11A-417 Add Z Check one: Certificate N(. Corporation `&f)OJ 10-6 v 4tit d. C2���S Business Telephone ! ) A • i) C- U7j C� ❑ Partnership Name of Licensed Plumber or Gas Fitter�gEj% �f~�Q/�[}��-j[� ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142. Yes X No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. T A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER:: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) In above application are true andaccurate 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 provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Title B y Signature of Licensed Plumber City/Town APPROVED (OFFICE USE ONLY) Type of Licenser aster ❑Journeyman License Number._ Date. e/-':� ��,� Ir ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,. ,_,�: Y �9SSACMUSEt�� This certifies that ..... i?.<. s ..k-. - - P .'.f• • • • • . • • • • • • has permission for gas installation ...... in the buildings of <7 — . • .. a .. /� at .. �'?.`! . 4 ....G? .S ` s . ........... North Andover, Mass. Fee. ?..... Lic. No..5.).5.. �...... ....... . f GAS INSPECTOR Check # �/ ) 7 54,52 .0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type)/ ,Mass. Oate�G Zp�_ Permit N%�- - BuildingLxation %' 0_c4oaLowners Name Type of Occupancy �M Mn �yui New❑ Renovation Replacement Plans Submitted: Yes❑ NOV Installing Company Name f141IL Address A&Y-'77 0. Business Telephone Name of Licensed Plumber or Cas Fitter Check one: Certificate Corporation wl1`f ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: '1 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. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on fff s perm application waives this requirement Signature o Owner or Owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the detalls and Information i have submitted for entered) in above application are true and accurate to the best of my knovNedge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. �T,yype of License: Tile YC�fi �r gna re of Licensed Plumber or as Fetter APPROVED Li aster License Number_? APPROVED (OFFICE USE ONLY) ❑journeyman s s • v�M MWM M W MM MM MM M MM Installing Company Name f141IL Address A&Y-'77 0. Business Telephone Name of Licensed Plumber or Cas Fitter Check one: Certificate Corporation wl1`f ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: '1 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. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on fff s perm application waives this requirement Signature o Owner or Owners Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the detalls and Information i have submitted for entered) in above application are true and accurate to the best of my knovNedge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. �T,yype of License: Tile YC�fi �r gna re of Licensed Plumber or as Fetter APPROVED Li aster License Number_? APPROVED (OFFICE USE ONLY) ❑journeyman Location C `t 0 «G 0 0:h c� �, No. 103 Date Seo lf 14ORT1y TOWN OF NORTH ANDOVER i • OL 9 Certificate of Occupancy $ '� s• t�� Building/Frame Permit Fee $� �cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ rg Check # FJ Building Inspector I A d r The Commonwealth of Massachusetts Not Applicable Q State Board of Building Regulations and Address: q4 -f, TOWN OF NORTH ANDOVER Standards Telephone q BUILDING DEPARTMENT Massachusetts State Building code a�g Telephon 6r 3 by 780 CMR Address (LAQJ *.Wr-A—)Q60,Av2,42 APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OF OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLIN Building Permit Number: ) / Date Issued: fo Signature: Signature Building Commissioner/Inspector of Buildings Date 1.2 Assessors Map and Parcel Number: Q0 F 0 Map Number rParcel Number 13 Zoning Information: 1.4 Property Dimensions:: Lot Area (sq) Frontage(ft) Zoning District Proposed Use 1.6 Building Setback ft. Front Yard Side Yazd Rear Yard Required Provided Rqu= Provides Required Provided 107 Water Supply 9M.G.L.C.40.4 s 54 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Q Private Zone n Outside Flood Zone a Municipal a On Site Disposal System 2.1 Owner of Record Not Applicable Q Name (Print) Z Address: q4 -f, License Number d�b$�� Signature 1c Telephone q �--G z—zz 2- 2.2 Authorized Agent: a�g Telephon 6r 3 by Name (Print #A A4 YiJ Address (LAQJ *.Wr-A—)Q60,Av2,42 Signature Telephone �j2+ Q O CF!"1`Tl1N 2 /'r1NCTr?riM•r U CCDVrlTi C L'AD DOl1 iC!•TC T CCC TU � N 1G �1nn lR LDi/� cCcm AC Twri.i iVor. r cm � r.n 3.1 Licensed Construction Supervisor: Not Applicable Q Licensed Construction Supervisor: 'T1MM Q6, License Number d�b$�� Address i 00 �r rJ r (� Expiration Date ° � Signature a�g Telephon 6r 3 by 3.2 Regi eyed Home harovement Contractor: Not Applicable Q Company Name PJ�O'u'L G07US lo,c) WG Registration Number Address 6S' b. -7 �it Expiration Date Signature Telephone(6'1-7 ) 13 j — � 1�GV1JGll 1]>// J1Vll.. ,L V SE , CION 4 WORKERS' COMPENSATION INSURANCE AFFIDAVIT [M.G.L. C. 152 § 25C(6)] 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 Yes . No 13 SECTION 5 - PROFFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDING AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 CONTAINING MORE THAN 35,000 CKOF ENCLOSED SPACE 5.1 Registered Architect: CffAJL_ C No Applicable Name (Registrant): Address Registration Number � GoL(366? c N o - r2 'i� ; G—• v (J Expiration Date �� � � one Signature Telephone 5.2 Registered Professional Engineer(s) Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name): Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 53 General Contractor !1� d�ItJC. Not Applicable Q Company Name: (305 (-rJ A _ 2)Z Responsible in Charge of Construction Ti MM Address &J p 6 Signature 61 i 3 3 Telephone 10b - OWNER/AUTHORIZED AGENT DECLARATION 1, `-,-' `9 11 /An I K r N � , 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. '( /MM Print Name Signature of Owber7Agent (T Date Y/6— /o c - SEC nON 11 - F.STTMATFT) C0NSTRTTC-R0N COSTS Item Estimated Cost (Dollars) to be completed b permit applicant Official Use Only 1. Building Zo a n v (a) Building Permit Fee Multiplier 2. Electrical ?j 6 6 o (b) Estimated Total Cost of Construction from 6 3. Plumbing z o a o Building Permit Fee (a)x(b) 4. Mechanical HVAC3 0 o a v 5. Fire Protection S $ov- 6. Total = 1+2+3+4+5) Check Number SECTION 6 - DESCRIPTION OF PROPOSED WORK check all applicable) New Construction Q Existing Building ® Reairs ® Alterations Q ® Addition Accessory Bldg. Q I Demolition ® Other Q Specify Brief Description of Proposed: � � - IA IB Q Q r/ c! nGw ` . Q brxa Go G ` tL SECTION 7 -USE GROUP AND CONSTRUCTION TYPE? A, .tte�tL✓ - 3 7za�-c,' SECTION 8 - Building Height and Area USE GROUP Check as applicable) Proposed Number of Floors or stories include basement levels CONSTRUCTION TYPE A Assembly A-1 A-4 A-2 A-5 A-3 IA IB Q Q B Business 13 2A 2B 2C Q Q Q E Educational Q F Factory Q F-1 F-2 H High Hazard Q 3A 3B Q Q I Institutional Q I-1 I-2 I-3 M Mercantile 0 4 R Residential E3 R-1 R-2 R-3 5A T513 Q Q S Storage Q S-1 S-2 U utility Q Specify: M Mixed Use Q Specify: S Special I Q 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 SECTION 8 - Building Height and Area BUILDING AREA Existing if applicable) Proposed Number of Floors or stories include basement levels SECTION I Oa - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Floor Area per Floor_(so Signature of Owner Date Total Area s Total Height ft SECTION 9 - STRUCTURAL PEER REVIEW 780 CMR 110.11 Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION I Oa - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 14 -SAV -P , As Owner of subject property hereby authorizq bj&�.-o7&VP- S G6,J,,Tt4zericoxJ (n1G4 to act on my behalf, in all matters relative to work authorized by this building permit application. p� --kms- 2Z'- Signature of Owner Date revises wag torm/state imu L FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION********************** APPLICANT t,�> h 1 t�-� 1�S S o 1'^-� PHONE of LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET (95 I G 0 ©� ST. NUMBER ****************************OFFICIAL USE ONLY ********** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT b /FIRE DEPARTMENT _ WOO "N% RECEIVED BY BUILDING INSPECTOR DATE / Revised 9197 jm � ✓� �a.��.uuea� o�✓�iavaaciivaP,tla °� BOARD OF BUILDING REGULATIONS �� ! License: CONSTRUCTION SUPERVISOR r Number: CS 076870 F. Birthdate: 01/20/1952 is Expires: 01120/2006 Tr. no: 13630 Restricted: 00 TIMMY CHUN WAH NGS 116 KINGS GRANT ROAD (�w•Ie-4 �i WESTON, MA 02493 Administrator Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 . Workers' Compensation Insurance Affidavit Please Print F1 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity r'C71 I am an employer providing workers compensation for my employees working on this job. vi tzw— 1 - Insurance CoA-404U.Ixi/ -- -. --- –• •-- --- — v ' v'v � penalties of,a fine up to ,500.00 Failure to secure coverage as required under Section 25A or MGL 1 can I to the imposition of criminal and/or one years' imprisonment_as.vkell_as_civil-penattiesin]hefmnof�..5T0 .WORK_ORDER..and..a.ftne of (.5100.00)�ltay against me. I understand that a copy of this statement may be forwarded to the Office of In ligations of the DIA for coverage verification. 1 do hereby ce,ti under the $sins and penalties of perjury that the information provided above is true and com!?ct. Print Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept []Check if immediate response is required Licensing Board p Selectman's Office Contact person: Phone #.• ❑ Health Department I] Other Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name PRESENT MAILING ADDRESS City Town Horne Phone State WorK Hnone The current exemption for "home6wners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFF Zip Code Nov 18 03 01:35p North Andover/Foster Ins 978-686-6410 p.1 ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION OAYE MM/DD/YY LIMITS 03131/2003 PRODUCER NORTH ANDOVER INSURANCE AGENCY, INC 03/06/2003 "' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 VMVERLY ROAD FIRE DAMAGE (Any one fire S 500,000 MED EXP(Any one Person S 10,000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE GCNCRALAGGRCGATC S 2,000,000 GEN'L AGGRFGATF LIMIT APPLIES PER: POLICY IFCT F7 LOC NORTH ANDOVER MA 01845-2415 A AUTOMOBILE X X X INSURED M9798905 ._ INSURFRA:NATIONAL GRANGE MUTUAL _ INSURERS: Arel Electric, Inc.' PROPERTY DAMAGE (Parseddant) y INSURCRC: 773 'W'ashington Street GARAGE LIABILITY ANY ALTO INSURER O: / / / / AUTO ONLY - CA ACCIDENT $ _ IN;IIRF.R F: Havarhill MA 01830- EXCESSLIABrUYY }� OCCUR F-1 CLAIMS MADE DEDUCTIBLE RETENTION S r_nvraAr.Gc THE POLICIES OF INSURANCE LISTED BELOW HAVE DC -EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PCRIQO 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. IN-" LTR TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION OAYE MM/DD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENE L LIABILITY CLAIMSMADE I X I OCCUR MP198905 03/06/2003 "' 03/06/2004 EACH OCCURRENCE S 1,000,000 FIRE DAMAGE (Any one fire S 500,000 MED EXP(Any one Person S 10,000 PERSONAL &ADV INJURY $ 1,000,000 GCNCRALAGGRCGATC S 2,000,000 GEN'L AGGRFGATF LIMIT APPLIES PER: POLICY IFCT F7 LOC PRODUCTS - COMP/OP AGG S 2,000,000 A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS M9798905 / / 04/11/2003:04/11/2004 / / / / / / COMBINED SINGLE LIMIT (Eaacelaent) S 500,000 BODILY INJURY (Prr prr:on) $ BODILY INJURY (Per accident) i PROPERTY DAMAGE (Parseddant) y GARAGE LIABILITY ANY ALTO / / / / AUTO ONLY - CA ACCIDENT $ OTHER THAN FA ACC S AUTO ONLY: ACC S A EXCESSLIABrUYY }� OCCUR F-1 CLAIMS MADE DEDUCTIBLE RETENTION S CU198905 03/06/2003 03/06/2004 FACHOCCURRFNI�F S 1,000,000 AGGREGATE S 1,000,000 S A WORKERS C ABILITY ON AND WC198905 03/06/2003 03/06/2004 Ut X � S�,,, .R E.L. EACH ACCIDENT $ 500,000 C -.L. DISEASE - EA EMPLOWIC S 500,000 E.L. DISEASE - POLICYLIMIY S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS FAX- 617-338-098B .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO 6EFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 OAPs WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT NG BROTHERS CONSTRUCTION FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 65 HARRISON AVE . , 6TH FLOOR INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESS TWE 1 , BOSTON ACORD 25S (71971 MAL 02111- ® ACORD CORPORATION 1988 INS025S (99m.ol j ELECTRONIC LASER FORMS, INC. - (800)927-0545 rage 1 of 2 :4CORD . CERTIFICATE OF LIABILITY INSURANCE DATE12/DD/004 03/12/2004 PRODUCER (617) 698-2200 ATLANTIC INSURANCE PARTNERS LLC 143 CABOT STREET NEWTON MA 02458- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Ng Brothers Construction Inc. 65 Harrison Avenue 7th Flr Boston MA 02111— INSURER A: NATIONAL FIRE & MARINE IN INSURERB:ST PAUL FIRE & MARINE INS INSURER C: INSURER D: INSURER E: 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. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A X GENERAL LIABILITY 72LPE691908 03/13/2004 03/13/2005 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx_ OCCUR / / / / DAMAGE TO RENTED 50 000 PREMISES Ea occurrence $ MED EXP (Anyoneperson) $ 5,000 PERSONAL & ADV INJURY $ 100,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICYPEC LOC PRODUCTS - COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO NONE / / / / 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 $ ANY AUTO E NONE / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY NONE / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR 7 CLAIMS MADE DEDUCTIBLE / / / / $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY / / / / TORY IM TS ER E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBEREXCLUDED? If yes, describe under 0165B485 10/30/2003 10/26/2004 E.L.DISEASE - EA EMPLOYEEI $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER NONE DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ADDL INSURED: RUPING BUILDERS, INC, HERITAGE REALTY TRUST, AND WOODHILL REALTY LLC 505 MIDDLESEX TURNPIKE SUITE 11 BILLERICA, MA. 01821 RUPING BUILDERS INC ET AL 505 MIDDLESEX TURNPIKE STE 11 BILLERI ACORD 25 1[2001/081 I*T INS025 (0108).05 MA 01821 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO,SdSMALL IMPOSP-00 OBLIGATION OR LIABILITY OF ANY KIND UPON THE ELECTRONIC LASER FORMS, INC. - (800)327-0545 cin AmRn rnRPARATInN -1 ORA Page 1 of 2 - I - 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: �4 (LoRation of Facility) 1) 1 116y) Sign ure 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 AUG -09-2004 10:16 FAY,SPOFFORD&THORNDIKE 781 221 5907 P.02i02 OFFICIO OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER -CONSTRUCTION. CONTROL M PROJECT NUMBER, pROMcT •nTLF. Renovations to the China Blossom Restaurant PROJECT LOCATION:. 946 Osgood Street, N. Andover MA NAME OF BUILDING- China Blossom Restaurant NATURE OF PROJECT; Interior Renovations, Facade Work IN A�=RDANCE W i � ARTI115 OF�THE MAS8ACHUSETfS.STATE BUI { DE; �LWAM_m` nllOn, REGISTRATION NO. M BEING A REGISTERED,PROFESSIONAL ENOINEER/ARCHITECH N1=ReVyGgIqMFy TjjAT I HAVE PREPARED OR DIRECTLY SUPERM$ED IM PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNIW- ENTIRE PROJECT 11 ARCHITECTURAL g STRUCTURAL Q MECHANICAL 0 FIRE~ PIOTEGTION d EL:EirT FiICAL Q OTHER -(SPECIFY) FOR THE ALCOVE NAM® PROJECT AND THAT, TO THE 13113T OF MY MOWLEGS, SUCH- PLANS, . COMPUTATIONS AND SPMFrATIONB MEET THE APPUCAME PROVISION OF YHE 11M S&4,CHiJSt=TTS STATE BUILDING CODiE. ALL ACCEPTABLF ENGINEERING PRATIM, AND APPUCABLE LAWS AND ORDINANCES'FOR THE PROPOSED USE AND OcCUPANCb_ I FURTHER CMT1FY THAT I SMALL PERFORM THE -NECESSARY PRDFMONAL SERVIOU AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC 6J I&Td DETERMINE THAT THE WORK IS MOOS=mmG IN ACCORDANCE V41TH TWDOC Ig APPROYEP-FOR THE BUILDINO PERMIT AND SMALL BE RESPONSII3 F FOR THE FOLLO"NO AS SPSCIFIE6 IN SECTION 110A 1. Review, for confonnamo to the dwge +Pf. dhop dmWngR awls aW:athar i ffsft whkh am submits d by the cotltractor In vAM-the F8WrWWft of 1ha-oors*uc5on docurnMlta, Z Review and apprnvat of this quallty•cot*d prnoe&m lora l oodgqequirod cord ed nvkwida 3. Be pre9er>t at lrrbervaiS appramprlde b tfle stage of cstruclon b beCOR,e, sei�eralh► famlllar wiMOthe progress aid qu@W of ttw work and to da�rr wmk in gftm al', if the.'vKwk is being perf wmad In *%nv rfer with sire corwmstlon doeL nlwft PURSUANT TO SECTION 11CL2.2 1 SHALL. SUBMIT WEEKLY, A PROGREW REPORT TOGETHER VWM PERTINENT COMMENTS TO THE NORM AWV#ER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK i SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCI IpAN - SIGNA RE AND SW TO BEFORE ME THIS AY vf= 2qd 7" Y BUG MY COMMISSIOIRES ROBIN A. YEOMELAIOS Notary Publc Common eakh of Mamchunft rjc( MyCortum®alon FxpogsApr14,2p11 TOTAL P.02 CA m m C x m y m Cos 10 CD CL CD O d CL aco � o o p CL c CD o °D CA 10 CD 0 n LOi y d S d O COD C O c CA C7 a O CD CD y� CD COD 0 CD 0 CD c3"o ? z o youQ aoSo .o y 0 a: O m n C � Q CL0 3 T CD Z �m N ? m .•gym = y CD 0 0 y p N o g of m S O m �' O o Z A. On O y !7 W ? � O O C� co p Cri a = = s m = COL : t m o OC CD ;ryCD ZCD cro .4w :oft 1 = QVft cn y� �CD: �. H O � �0 e �� _ N q 3 aH M ao mo O'er• � �P vs o= O :0 r r: O T cn •',4 a, y rZ t h o �a '^r1 ro ro 0 c Michael Kim Architecture Transmittal Date 8/26/2004 Project China Blossom Restaura Project No. 53460.00 To: Building Department 27 Charles Street North Andover, MA 01845 Attn: Robert Nicetta We are sending you: Prints x Construction documents Attached x Mail Shop drawings Specifications Under separate cover Hand deliver Samples/Submittals Copy of letter Copies No. Date Description 1 6/7/2004 Detail Drawings A1.01 - A6.02 These are transmitted as checked below: For Approval For review and comment Returned for corrections x For your use Approved as submitted Return as soon as possible As requested Approved as noted x See remarks Remarks W- PE2 a0(L P►iaej e CAv— TdOM , NCO -L, Aga= TME AFTAtL_ (&L -7S TMT weke Kssiy✓ F-,201 'NE eERttif—I SET ALT&111-1-1J ,pAWiIV,5 J5qJv fi►CE A"01 RAMA)43 WILL $E SEM- 'R DIC fief Dem AS S040 AS PaSsAC- P LEAFS C FEC --L. fZE1 JZ) CALL W (TFI ANY QUESTt cry S . Michael By: l chitecture Copy To: gkC(PRii;O TEE, C4101 i&U%onsIA)R✓� : JACIL Oc, + NC, bQ-oi E&.5 16P9T)WC-ro►J �'f crrs►t��. ow tsl � RECEIVED AUG 3 0 2004 nichaelkimarchitecture.com 15 Colbourne Crescent Brook2S- mkimC�mkimarch�tMi .mi Y 5.11 1 ( r': r, ".+ Micheal kim FAX MEMO to: Robe" Nicetta, North Andover Building Commissioner 978 688-9542 from: Michael Kim re: Firestopping Detail date: 2 Sept 2004 cc: Connie Yee, Jack Ng pages: 2 Per our conversation today, please find attached a detail for flnestopping at the South exterior wall frieze If you have any questions on this issue, please call. -Michael Kim tz '31 o 021 ro (?-T-- wr; ituu o cyte__k, 3- ,/,. F_ www • r..: lr„Llkinl:.ri l�.ileGtrt� Imlll RECEIVED SEP 0 3 2004 WILDING DEPT I C014ourna Crr.srent 8reoklinu MA (11445 T 611.139.021 mkim4nikimoirhuertlire cow F 772.17; 25rif TO -d T66Z+9Z£+ZLL+T WIN 13VH3IW Wd 67:90 b0—Z0—d3S pvft W/O oilsf. wef of Qecx- 'WOL. Nook Wrice RECEIVED SEP 0 3 2004 BUILDING DEPT .... . ... 04mry Tww DFAWN wyioi lwovacns + MOM MOM @ C4n& B(Ossc"L Exterior Freize SM 61 Oslo J; 94 MgoM St, North Andover MA j I Sept 21004 Zeld WIN 13VH31W Wd 6T:90 *10-zo-d3s 0 M.. x . ��i;�: Michael kim . FAX MEMO to: Robed Nicola, North Andover Building Commissioner 978 688-9542 from: Michael Kim wHorizontal Firestopping Detail date: 3 Sept 2004 cc: Connie Yee, Jack Ng pages: 3 Per our conversation today, please find attached details for horizontal firestopping at the South exterior wall frieze. The contractor is directed to assess the existing firestopping at the completion of demolition, install new firestopping as necessary, and have it inspected prior to covering up. If you have any questions on this issue, please call. -Michael Kim wwvs. m.ahnclhiu,nrcl:ilr,c•:uracum DECEIVED SEP 0 3 2004 BUILDING DEPT. 15 Colhaumw Crc,ce!a 0raaklaw Mn 0114:1 T 611 1'19 (4915 rr�kirn�mkimanad;c� iwe �r�m F lil ai5: x!11 TO"d T66Z+SZ£+ZLL+T WIN 13HH3IW Wd LT:£0 b0—£0—d3S SEP -03-04 03:18 PM MICHAEL KIM 1+772+325+2991 P.02 1 a tv o -V L. N 26 32 Z O c r.. N 4 tlp r +) I ?1 0 F T N i 'RECEIVED SEP �u04 BUILDING DEPT A SEP -03-04 03:18 PM MICHAEL KIM 1+772+325+2991 P.03 s % d1� r c r R EcE jvEa '..� SEP p 3 2004 EPS x CD n CD O v CD C/) X, co SW C) 77 m cc o' C O U N C/? Y Cn CU 0 C O CL) U Cid C CLD p cz U a� C O CL C O t - V II r%Q� CV U r T 1 C I N Cn p CCS H � � Y O OO m LL _H JCC O LL � O C OD < ICD Cn 1 1 1 1 1 1 C O U N C/? Y Cn CU 0 C O CL) U Cid C CLD p cz U a� C O CL C O t - V II r%Q� CV U r T „0-S H cn co OO OO C C O O a U O < Z cc Z O C) M < O 2 < Z C/3W A ' 1 4 r C N Cn p CCS H � � Y O OO m LL _H JCC O LL � O C OD < ICD Cn „0-S H cn co OO OO C C O O a U O < Z cc Z O C) M < O 2 < Z C/3W A ' 1 4 r W J CCS C= W CL Q LLJ O CL QLu C= o z D II C+ a+ T J W Z Z O G f= Z � O Z M 0 O U U W J Q Q W N A o Z � T 0 a J W CC U Cl cn Z cr O O m O CD >=°a} cC Q F- a J W Z ctCl Z O m C=) J Q w 0 W J Q W C) Z O V c+o w� LR! co N C+M W Q m C!3 O 2 Q M 11 Z C O VI O W m C/5 �7J �7) 6 A cc C/3 cl W U � LL- C. VJ rR O J � m Q O rIN T ' fri/)MA NMm. \ Q • .r 71LI z J LJ.J - ---- -r all? I— Q w cc C/3 cl W U � LL- C. VJ rR O J � m Q O rIN T ' fri/)MA NMm. \ Q • �Iv 71LI z J LJ.J - ---- r all? I— Q w _I H cn J _ o Q II MM W CA,> J W Z Z d J m Q cn Q Q U ~ W U Z � O Q V' cc C/3 cl W U � LL- C. VJ rR O J � m Q O rIN T ' fri/)MA NMm. 71LI - ---- - all? r— O J U cn Q Z a. Q O CWI N C/3 J S Z J e Q e J Z z O h C C LLJ W C [r to F— Q X J T CL q Cr LL W J z LU CC: N C5 d W p W cc: � CC = Q j � Q J Q SWC) I � cna- C/3 Uj cc: Q LLJ LJti Q J WCL W r q W3 W n W< w q = Q W� >- w i q 3w <LJ < CC X LA- Li J � U _ LD_ QO % J Q� Li QQ' (,o 0- o WQ W3� > CZl Z Z F- z L` Q' l� O q _ ALJ W��' ¢ J W Z �Li 075 Z L.� W N0� d. r i- 2 � a- Q� M ¢ L7 Q0�QQL CL �(Z/) z F— z (n Q W --, W i q L� W W Z F I r �I IR W N W FE LA— AM i Z zo U y 2 Cr LL W J z LU CC: N d W � Z m °b cc p W cc: Cc CC = Q j z`tw_ SWC) cna- C/3 Uj cc: Q J WCL C!3 Z_ z CDLL N W C� CC: Q d W 0 -J F- F- J d O Z Q J CC X LA- Li J � m CL¢ _� U N O CC Z Z F- a.W U)CC Lu OU WC1CW C'33:cc: =QN V CO r �I IR W N W FE LA— AM i Z zo U y 2 C) O M = O Vi w z C) C) w O =d J U. Q N C-) n" >- ¢ T U C~/) O O J cn M - M 08/27/2004 10:24 FAX 160011002 NG BROTEMM CONSTRUCTIONINC. 65 HAMSON AVE, 7/F, BOSTON, MA. 02111 TEL; (617) 338-0988 FAX: (617) 338-0881 FACSDJILE COVER LETTER TO: k DATE: W Z% D - COMMA"- NUMER OF PAGES OA7t: FAX#: i If you do not receive all pages. Please call me as soon as possible. IMank You. MMSAG)Z: ✓L�A.�o,�- 5` �e.sU 08/27/2004 10:24 FAX FROM 10002/002 (THU) 8 26 2004 22:12/8T. 22:1210.5113006155 P 3 ACQRQ, CERTIFICATE OF LIABILITY INSURANCE Q§12"1`' 27/2002004 PRODUCER (611) 699-2200 !►TZutTSC ZI+s+<rnAIal->E pAtXTI6sRe LLC 530 ADAMS STREET >rQTi7N7iIi MA 02186- THIS C OMFICATE IS S A MATTER OF TION ONLY AND CONFERS NO RIOMU IPPON THE CilMICATE HOLDER. TRIS GERTIFICAYE DOES NOT AMEND EXTEND Olt ALTER C VERAGE AFFORDY THE Mika W. ENSURERS AFFORD= COVERAGE MAIC N wiuREO Ng Hrothere CoftatifiAation Inc. 65 Harrison AvOt a 7th Flr HOYtOl1 MA 02111- M6uR • NATIONAL )!'M 4 MARINE wauRgRBLST PAUL FUM i MARINE RtRC: INSURER D: INSURER E. THE POUCIU OF 14UPANCE LISTED BELOW HAVE SEEN =MTV TO THE INSURED N111AED ASOft FOR THE POLICY PWOOP INDICATED. NOITYNYNSTANDINO ANY REOUIREMI NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENY YNTH RESPECT TO WHICH THIS CERTIFICATE MAY 0% 1Q4uED OR MAY PGPTAIN, THE INSURANOR AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGi:BGATE TS SHOWN MAY YE bIEN RSOLICED BY PAID YtSR TTTE OF N URANC! Pumm NU0061 (EOPFRATM7M N1 RTit GENERALLIAOAJTY 1.000,000 1d1TEC t 50,000 X COMMERM4114WAALLtUILRY mmwiswm occ 72LDWRI902 13/2004A 03/13/2005 t 5,000 P61901ALAAM S L,000,000 / / / / GEN t 2,000,000 GE11LAGGREGATE X MffAPKiiFRR: AGG t 11000,000 ►OLICV 29 M LOC AUTOMOOLE LIAOILnY ANY AUTO NCM / / / / 00e01149 SINGLE LAW F IPA pmckpml ALL OMMIO AAROA SCHEDULED Avrot / / / / BOWLY INMRY BODILY INJURY (om) A HIRED AUTOS NON-0NNED Auro6 / / ! / 049P6nTY DMIACE IPS mid") i GARAOA LAAWLm Aura ONAY. ACC0W t µYo 310NFI / / % / OTNERTNAN EA ADC i AUTO OWLV: Ase t A1R;FSAIU40101S LA NAAILM T1016i ZACp_0MURRlNG& t AGWOATS 2 OCCUR ❑ CwN& UAJX 0E01.007I6LE 1 111gN S 8 VMWWwCOwML4TWAm ANY PROPRMTORIPARTNERUECU'WE 0165s665 10/30/2003 2.0/30/4004 UA& I X lCit R.L.EACNACCIOENT t 500,000 DOWASE . EA EE t 509,000 OFFICEPAXWER EXCLUDEDf Mym dpob%6111- ECNL PROVWONS era. / / / /S6 E.L. DISZM - POIACY Luer It 500 , 000 OE$CAPTIDN VPOPt1N7101gM1AGA7yorW�CLeMLJtMows Aeoeb BM DOMawovAiOMi L4C1 966 06000D DRXVE, MR72 A"Dowk,)m F(m 08LzhbrLlt" AND t10RKR" CON!lA "Tzaw OPLY 21IM =OR Ail'1blftTIG MIRI" Rou"7111UM or pRffiA16. C2RTWrATE HOLDER rLIANCELLATION Sm"D ANY OF THE ABOVE 04WAW-0 POLKNO X4! CANCELLED INIFORE THE 00 4FA=M OATS TNS110M THE 1!!10110 BUIURER WILL ENDEAVOR TO MAIL LO DAYSTMITTOI NOM! Tv THE CM11M1CATE 1101AlR N101Ep TO TN! LtiT, atrr TOWN OF NORTH ANDOVER FAILURE 10 00 90 ■MALL II No mu4AT10N GR munm► OF ANY RIND U US ATT1T: GM NICZTTA 111= DEPT WORTH ANDOVZR ITA CORD 26 (2 IMS) O ACORD CORPORATION ION -: w4m (610%AS ELJ<CTROHIC LASER FOR IA W- -P*3274W ►roe t a 2 FROM (THU) 8 26 2004 22:13/ST.22:12/NO.5113006156 P t ACORD. CERTIFICATE OF LIABILITY INSURANCE °"'�`'°°"""' 09127/2004 mww- ER (617) 696-2200 ATLANTIC INSURANCE PARTNERS LLC 530 ADAMS STREET MILTON MA 02186- THIN TIFICATE 18 163UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS IPPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC N INJURED Ng Brothers Construction Inc. 65 Harrison Avenue 7th Flr Boston MA 02111- MISURER A NATIONAL FIRE i MARINE wmwRB:ST PAUL FIRE 6 DIARINK INSURER C: INSURER 1 0"ERE: 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 I Y PAID CLAIMS. MSR TR AWL TYPE OF UOURANCE POLICY NUMBER POLICY IWDWM DAT! LIMITS QMRAL UAOIUTY ! / / / EACH OCCURRENCE a 21000,000 P SES aNm�iws B 50,000 ii COLNILRCIAL*ENERALLMBLRY mEO Exp IAmv aro pwwm s 5,000 A CLAIMSMADE Fx-] OCCUR 72LPZ692900 03/13/2006 03/13/2005 PERSONAL a ADV INJURY a 1,000,000 GENERALAOGREGATE S 2,000,000 GEMLA00AEOATEI.IIMITAPPLIES PER: PRODUCTS -COMP AGG 6 1,000,000 n POLICY OJPRECT LDC AUTOMOBILE LIAMLITY HOME / / / / COM IED SINGLE LIMIT = (E..aeldw.) ANY AurO BODILY INJURY S ALL OWNED AUTO& (P« pwoon) BCHEDULFD A1.1101 60DILY INJURY 6 HIRED AUTOS / / / / (Per.odewa) NON.OMNED AUTOS PROPERTYDAMAGE 6 (PIM ow-dwe) GARAGE LIABLLRY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC e ANY AUTO NONE / I I I AUTOONLY: A00 E EXCE9sAIMORELLA LIABILITY NONE / / / /SACH OCCURRENCE s OCCUR ❑ CLAIMS MADE AGGREGATE S s DEDUCIBLE I I / ! S RETENTION e � $ wORRERi00Nl3ATIOMAND 01658665 10/30/2003 10/30/2004 X ER GIMILOYlRW UA§N ttMf E-� EACNACCIDENT s 500,000 ANY PAO►RIETOalPARTKfvEKECUYIVE OFFICERAAEMBER EXCLUDED? / / I I El- DISEASE . EA EMPLOYE t 500,000 N yes. draft una.r PROVISIONS be E1.OBEA&E •POLICY LIMIT e 500,000 aRIlPECIAL PM, OF OPERATIONMADCA7KNaftUNCLOMCLUSIDNs AWED By ENDORBwrNTPMEaIAL PR M SIONS LOC: !46 060000 ORM, 1M WM A1MDOVEIL,NL FOR GENERAL LIAMILITY AM RORRERB CO WUNSATION ONLY IITPBRIORL RE3WYIT/G .iFMzm RERABILATICK OF PRImaliE8. ( ) — SHOULD ANY OF THE A604E DEWAKO POUCIEB BE CANCELLED BEFORE THE EXPIRAWN DATE 7"BO 0F, THE WSuWG INSURER VALL ENDEAVOR TO MAN. 10 DAYS YM r MA NOTICE TO TPM *WRpWATE WDLDER NAW0 TO TME LEFT BUT TOWN OF NORTH ANDOVER FAILURE TO DO EO SHALL IMPOIRL NO OILJGATON OR WAILJTY OF ANY KIND UPON TWE ATTN: BOB NICETTA IM1141IRM10<06 nORR Es. BLDG DEPT NORTH AUIDdVER MA — ACORD 25 (2001/041) O ACORD CORPORATION 19410 INS026 (weps ELECTRONIC LASER FORMS. INC-. (11W) 460 Pop i v4 2 OCT -13-2004 1422 A ')-HY,SPOFFORDBTHORNDIKE 781 221 5907 P.02/02 . Iwo ud%* "mb— TO r"Fr J)W L*#A' vSe S 50�' w N qt 434 6R�t� TO wlN�r u T G WM -allp �p Chvoi S EXST 3x14 MkW BEAM 0 2491 Or. TOTAL P.02 0 Co T Co T C? CJ) ALL 3 ROUGH OPENINGS ARE 7'-21/2" TALL Renovations + Additions Drawing Title Drawing Number DR1 South Wall Opening SM0 946 Osgood St., North Andover MA Date Scale 23 August 2004 1/2" = 1'-0" IS7 1 1 1 1 C� 140 7' M 1 0 Co T Co T C? CJ) ALL 3 ROUGH OPENINGS ARE 7'-21/2" TALL Renovations + Additions Drawing Title Drawing Number DR1 South Wall Opening SM0 946 Osgood St., North Andover MA Date Scale 23 August 2004 1/2" = 1'-0" I � o LU ZIa WI U c co O N E v 0 0 N C N m 1 CD N 0 U) C7 a�A 1 Lis Z ', c ILA p WI U co O N E v 0 0 N C N m 1 CD N 0 U) C7 J M J d CD Z J U O w W J S y o C _ cz O II C:3 , O (D I o m Qi N c Ycu Y- Q q Q � O � m O CO LO T C/) 1 � o w 72 o .! u� cz II Yn O Co rt 0 �Z C 20,8' 1 C Q LO T C/) 1 � o o cz II Yn O Co rt 0 C 0 N C Q oCf) o M d g4 michael kim 15 bu!bo,une Ci arort 6mukl6e Mh 02445 7 6 V 73�J.0325 . mkirt,NrraV:imarchitrclurc.rom 'i7?.3?`.i?°1+7 ienovations +Additions 7Date Drawing Number ng @ C f © eize SM 6 Scale 946 Osgood St., North Andover MA 1 Sept 2004 3" = 1'-0" CL w s eA V s r z W J � e T• Z o ¢R4 a� s _�1 L J Q LL- n L CD o 0 N �L 0 N � oLL w d o M x Qk an V dl oe 1 o Z � y o co v 71 . b7 S v t � F V E _ _2 Go a- st- 2 2 a� ku 1 h.� 0 2 s t s � . �za u a J �,. 3 J Z?v � J V J J C Q 0 N o 0 O a�W 0 < o O of T O D O A VA 2 N 52 2 � — 0 a wrw l F o z z LL of �- E Y _ � E � O 0 ¢ ¢ - _ m t E t� u E �E y � O U U h O an 00 O y ¢LL Ov O JJ _+ W F�- o 0 0 0 0¢ sZ W J J O -111 1 w O ZF � `yO U L O U ¢ O Z � w No ®" O r O o 0 0 .Z -.Z t O 2 010 IN I o 0 o v O 00 O m U 00 _ r 9 o0 h 2¢ = 4r F �� 4 O Z S N 00 �. �" 00 :EF o O F � Or •' • '� O" .noLL��"o CO O �*�, 00 y � g @ �Qo�oZ �JSzy- �w�a6ua¢,a uat Foo 00 00 O ^ t0 ss 77 0 U 1 O -00!:; 00 Z p a a 0. z ai a- o W 8 40 0 0 rco" z ¢ 2 O J LLJ wo o z LL w Lu Z �3 co �y TC N C Q 0 N T � � O !A QC O A 52 2 � o E Y _ � E � _ m t E t� u E �E U E i I T N E MMO cc: � O O N cn C = IM o r � c z E — a E N w U I I o O I I I J \ W d J cr O O U` U CIO 57< w J C7/ \ Z LOU- O LL. Cf) � O CL cnx LL\ I I I I _ J O li ci O I U U Z LU � O ---X cr J O I F— Z V) x J U I Z Cr 1 X ----�J w w LU w li z = U m —i J W Z o \o o O z w O CD a O ____ 0 0 „g I U r I r I I` I I I I o Do_. ate❑ W X S z CD O o J � � O w x z r— z 0 U Q 0 cjI / 1 O U) t- cn z w x O Z J O I C3 U I J Z I � W IW W _ J z � W W U m O /Q J o Ow o Z C3 O w i U r „8 I I 0 cjI / 1 O U) t- cn z w x O Z J O I C3 U I J Z I � W IW W _ J z � W W U m Rid Q O /Q J o Z C3 O w i U r „8 I I r _ I Q I Rid Q _ Q co w _ C. -N O I— Cc _ Ll LL H — —N J _o �o CD LU C=, 0 o LL CO =m CD > J � � OC 0 LU m F- m --- < cn c Y CD Q U E u- Y J 0 C0 J p X Q w = T 5 C:i O CD W cC a lz Y o z Q O Q wO V z c o / 2 L C/� Q J N W J co w J C3 Z � Q LU L CC . 01 F- LU J H C-) j m � W U i CD ; F- i U X w i I UD Q J Cl- Cf) LC!) LU c - LLJ C) / b 0 W LU w G) W ~ Q cC z J CD 0 F- CD x � U y w F— z = CD 0 0 J C/� .9-.6 w w z z Z � Q LU L CC . 01 F- LU J H C-) j m � W U i CD ; F- i U X w i I UD Q J Cl- Cf) LC!) LU LLJ / b 0 W U J G) �\ J Q Q N 0 J J 0 00 IZT J C3 F- Z_ LU Cr m =:) CC LL O m(D u J� C/) LU F- CD J �z W 1/ W i ® w ° Lj U) I Q C:) m � � J z N N Cr W_ d C'3 � z z F= X R � I w W J U Q a W C) W W F- C'7 � m W C/) U W U � LU o cc m ■:::::::::::■■■■:■::::..... :■■■■■■.■■■■■■■■■:■■■. ■■■............................................... .......... ..........................■■..■......... ............... .................................................. .................................................. .....................:....:...:.:.............. ......................... ...... .................................................. 0 u z N X \ W J\ z 0 W J_ F - C3 Z J_ W U M W m 0 J 0 U Lu OC z C3 L 1-- w z m Q U 0 w Q z z p J Q W LU J z w C j II Q w W J Z Q 2 W M Q J LU m m J F- W Z_ C� _� N z r Q C) N P7- Q Q U_ � 2 W U J W � r 0 u z� C/) z O LU LU J J Q LU J H U) C!) ;-- J< II C Z LaL F- z UD Q 2 x W z U J Z U -i c~n U X 0 LU W F— L:) U Li -i J LU cc m J W W T- r^� T n N LU w J i Z � F- ~/� Y C / b 0 U 0 �\ J N 0 J 0 0 .9-.6 Z LaL F- z UD Q 2 x W z U J Z U -i c~n U X 0 LU W F— L:) U Li -i J LU cc m J W W T- r^� T n N LU w J i Z � F- ~/� Y C L 9 51 loo A a D n M nnd .r W VI L Q J � 3 S d � v J � ± � v a Lt V L 9 51 loo A a D n M E Z+I W� NId - 7NiN�dO Q��I��1'V 1p � N Y 11VM 'SIdan Nvld cn PTO ?)Illl.i 431014 �o HSa►M �nn� 00�W w x[ I- ,--_ V.`p%Wkl�fl�1 �x� Z 'n 'NVQ - -n4M -o I *► IIA3 a NOIlIdNO dN3 "IINVd 11o�SNJVM M Z N FS%e o C/) s F- 10, 2'-6" 4'-8" 2'-6" }I 4'-8" 2'-6" 0 O 0 411 PARAPET ELEVATION ,�1_ f)11 Renovations + Additions Drawing Title Drawing Number Coat Room Entry rn i c h a () I k i m i C 'x:{1."wr;e Crescent E;rx;'Iiine c: I Date Scale ���■/�6 772 325 299: 946 Osgood St., North Andover MA 14 Nov 2004 3/4" = 1'-0" Renovations + Additions Drawing Title �Drawing Number Dining Room 1 m i h a e I k i fil j " z g Lighting Revisions . . . ... ... ......... C[0 S S 0 1141- S K 2 7 Date Scale . 2 9: 946 Osgood St., North Andover MA 18 Nov 2004 as noted •- 4 u Qj Yt/, a S G a a Location No. I l _4b 0—Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee C`� T $D TOTAL Check # 16'144 Building Inspector CO"0AWWE4LTH OFAM&4CHUSE7TS TOWN OF NORTHANDOVER • . % 27 CHARLES ST APPLICATION FOR,CEI?TIHCATE OF INSPECTION Date (� Fee Required (Amount) () No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,1 S, I hereby apply fo, Certificate of Ins,pectFon for-the.below-named pre seslocated at-thefollowingaddress: Street and Number_ Name of Premises Purpose for which Premises is Used Licenses (s) or PiernW{s)-R- ired for the Premises hy-Ot w-Go-verrwmental Agencies: License or Permit Certificate to be issued to Address Owner of Record of Building Address Name of Present Holder of Certificate Name of Agency, if any Telephone SIGNATURE OF PERSONS TO WHOM CERTIFICATE TITLE IS ISSUED OR HIS AHTHOIRIZED AGENT DATE INSTRUCTIONS: 1) Make check payable to: Town of North Andover _ 2) Return this application with your check to: $uildingLkept. 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-cerlocate 4VWl be Issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # I lP 1 q q - &00-3 E"IRATIONDATE: 02 — t) a CO 01 ' FORMSBCC-3-74 REHSED 21"c OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECT40N-REPORTfORM CLASSIFICATION PASSES INSPECTION yes o 0 DATED_ OWNER -- BUILDING NAME Ott -NO. C� t Cc�� swu , STREET LOCATION TYPE OF OCCUPANCY .- -Day -Cam-C er E 4,ud..0 .-Cafe B -Gyfn E W. 0 School 0 Common Victualer's Liquor 0 Place of Assembly 0 Other 1C �S� :z. UN OCCUPANCY NUMBER _ {indl -stories # ,aw:Q-0mmicv E'kQ.yn,S . w4toor - use rev �e side � � $ � Toy" E X I S T I N G S EXIST SIGN yes 0 no 0 LIGHTED EXIT SIGNS -operable yes -0 ne -0 EMERGENCY LIGHTING SYSTE M operable dry cell 0 wet cell 0 SPRINKLER SYSTEM operable gage pressure yes 0 no 0 SMOKE DETECTOR operable yes 0 no FIRE ALARM SYSTEM-e0ratien-date -yes .0 -no D ANSUL SYSTEM MOV -,oz, yes -fp no 0 FIRE ALARM SYSTEM operable municipal 0 yes F no 0 ELECTRIC EQUIPMENT PROPERLY PROTECTED yes -H no 0 EGRESSES LAWFULLY -DESIGNATE unobstructed 0 -res ;n 410 0 STAIRS PROPERLY RAILED yes 0 no 0 HALLS AND STAIRWAYS LIGHTED yes A� no 0 RADIATOR GUARDS yes 0 no 0 COMPLIES HANDICAPPED PERSONS LAWS � `� i0 0 FIRE RESISTANT CURTAINS OR DRAPERIES i HOW HEATED r— NO. FIREPLACES yes 0 no BOILER ROOM CONDITION A�tfi VENTILATION '� L UTILITY ROOM - CLOSETS fL ff ] NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS M 0 51 FOR INSPECTOR USE ONLY Revised 2/99 imc 0 O m r) rn H rn 0 n z rn F—I O z O Q �j n O _ �Y 'O O O '0 � .a 0 n !-� 3 n r+on an 3 n3, z z Y0 rO D �0 Z = N N 'W H o O �D Z 3 � 3 3 CD 0 O -i 0 a a, V) rt a _ U CA at �-O = b N N CD O < CD OLei m � m rn ' n N = r r r to cn -0 z 0 0 co f D CD Ln a 0 0 0 oo� (D0 W Ln < a, o. ' cn U) CO) Z ° Oc 0= o °�' 30 z �-i <� 0 Uo n n —q _ 0 : 91) S ° n a o y n ov N n o H .��..� =rD W C �o �W n 20 ..* o °� 0 °, m O � 3 C s 0 0 3 m o a � T n o m C m m z n N X -� 0 0 0 0 a n n 0 0 0 r) rn H rn 0 n z rn F—I O z a n O _ a m � n A. 3 30 `D 3 n3, z z 0 rO D �0 Z = _ -n �D Z 3 � �< cn 0 ; L, n _ 0 0 a, V) rt 4 p 3 C) 0 AD -A H Z Z �Ln m 0ul D 0 O 3 b n � T7'1 m D rt Q 3 n �z z O M 0 .0 n 0 � m I n 0m0' =M ,L � -�'4-1 z °' �z � go fA N O c n aor v = C O 0 Cn z tn cl0 in lw 01 �, N �- 0 3 w (D 0 -n n o D M 3 ((D c = 3 a cu n n 0 0 ° z z fD X 3 0 0 m� roo 0 0 �.. CA fD 0 0� a z <(D' O A 0 Z o m o m D su c� n, {D ° aO =' o °� = °. Z V) v+ �, o O An 3 X R a n O cr .4Am >> o 50 Z Z O D n a, r Z 0 z N n G) ;u 0 x X D O X 0 m D -M Z Z �Ln m 0ul D 0 O 3 n � T7'1 m n rt Q �z z O M r) -n m (D O r O ,L � -�'4-1 z °' �z � Mo O c n ��n v = C O 0 Cn z cl0 in rt N No N0RTM� 0 Date: ?.: TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...Ll!� l !. '... A- 5 �.../� .�� has permission to perform ...�... � .................... plumbing in the buildings of .f-. 24 sr.`. i at. �l .! ........ s ..`i. c .................... North Andover, Mass. c 7 `.. .. r PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Sf Owners Name Ch! d 6 550 Permit #____ Amount_ --- Type of Occupancy R 6? S f-aq ! ctr) 7! f' New Renovation Replacement Plans Submitted Yes M No FIXTURES (Print or type) Check one: Certificate Installing Company Name WAdel el p0Ck P f /V CO !-A ® Corp. 16 O Q C Address 13Q X 2 8 Partner. /,(a, l-1 r) d 0 Ver , iS•1 O Business Telephone q78 775 ¢ 2 q q Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy P1 Other type of indemnity Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not, have any one of the above three insurance 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 ued for this application will be in compliance with all pertinent provisions of the Massachus State lumbing Qbde and Ch ter JAZ of the General Laws. By: Signalure of 17censea.um r Type of Plumbing License Title o Is 9 City/Town rcense Master Journeyman ❑ APPROVED (OFFICE USE ONLY Dille* Oat 0.1r The Commonwealth of Afassadjusetts (� �•. l Department of Public Safety . ocr. .r.q t 1.a oadra DOARD OF FIRE PFIEVE1171011 REGULATIONS S27 CMR 12:00 1/90 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AU .•ark so l.e performed In accordance w4lhahe }laasachnresra Elicukal Code. S21 CMR 12:00 q/ (PLEASE PRIIIT IN INH: OR T SPE ALL 111FORIIATI011) • Date. City or Town of 60F)c To the Inspector of Wires? lb6 undersigned applies for a permit to perform the electrical work described belov. Lection (Street L Humber) 77' (n 0toer or Tenant o.mer's Address. Is Ithis permit in conjuncZe-5 with a building permit: Yes 1:1 Ito Ito (Check Appropriate Box) Purpose of Suilding `r1i,�9L 4-V Utility Authorization ►10. � Fdssting Service Amps / Volts Overhead ❑ Undird ❑ No. of Heters__ New Service Amos / - Volts Overhead ❑ Undtrd ❑ Ito. of deters %ober of Feeders and Ampacity location and Nature of Proposer Llectrical Work /�� N�F&o �-� � No_ of Lighting Outlets No. of Ilot Iubs Ito. of Iransformers Tota KVA lla. of Lighting Fixtures g 6 Swlsaaing Fool rode n- grove ❑ S n ❑ Generators KVA of Receptacle Outlets Ito. of Oil Burners two. of Emergency Lighting flattery Units lis. of Switch Outlets No. of Cas Burners FIRE AIAPIIS llo. of Zones llo. of Detection and Initiating Devices Ito. of Sounding Devices Ilo. of SeIE Contained Detection/Sounding Devices icIpal local 1-1Connneectictlon ❑ Other Co 16. of Ranges No. oEtAir Cond, Total tons Jim- of Disposals No. of Points Total Total I ns KW too. of Dishwashers Space/Area Cleating KW Ra.. of Dryers Heating Devices KW 11v4 of Water 1lesters KW No, of No. of Signs Ballasts low Voltage s Wiring go. hydro Massage Tubs No. bf Ibtors Total IIP s. QWIER? L IIASURAtICE COVERAGE? Pursuant to the requirements of Massachusetts General Lays D have a currentL billt Insurance Policy including Completed Operations Coverage or I substantial ejuivalent. YES 110 [J I have submitted valid proof of some to this office. YESie10 u] 11 you have checked YES, please indicate the type of coverage by checking the appropriate box. ENSURAIICE OND ❑ 0111ER ❑ (Please Specify) ' � xp tat on ate Eatimsted Value of Electrical Work 9 0 U6rk to Start Inspection Date Requested? Rough FinalY�. c -at -ed under the penalties of 1•erJ:•ryt ' > i FIRM HANE �� /-PC' �iIL�C _ LTC. no. Lietnsee Signature >� �x PLIC. N0. 4/0� • lAddtess- 6�0 � 4, .Pit d � S Alt. Tel. Ito. 09WER•S INSURANCE WAIVERt i are aware that the Licensee does not have the Insurance coverage oris ■t- stantial equivalent ss required by 11asenchusetts General Laws, and -chat 0 signature on this permit application valves this requirement. Owner Agent (Please check one) r Telephone No. ° PERlllt FEES Signature of Owner or gent •a c Date ....... c ...°� . 465 NOR7M Ott��to .•,ti TOWN OF NORTH ,#NDOVER Y PERMIT FOR WrO1G ,SSACNUS� O Cy �,0 This certifies that _ �G4.6^... E.! T � �"f'......... has permission to ..�........................ perform ....... 1?.' ...... w1%fe wiring in the building of.'...(:-. ?.'. �` u ✓ fU v 3 2 ........................................................ at .......9....... d S.l..................................... .North Andover, Mass. Fee. Lic. No..... :L.... /``1.......................................................... ELECTRICAL INSPECTOR C(z��1`9 WRITE: Applicant CANARY: Building Dept. PINK: Treasurer °`'•`'° :•'"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ......:.................................�1....,......................... m has permission to perfor'.. ��..; ..�::�;!..!FJ�.jj.. .. wiring in the building of!.4:�.f .�:!.�L.%!..1�►,+!..��f Al at .../..`r� /-� North—)Gd-'o'ver, Mass. y.........w.... ..y/....r......//,��.... .......Kr::s.. , Fee....?..:r .... Lic. No%..?.,r (. ......... ............................ .............. n�� �LE�ICAL INSPE T� Ch k # (o� Commonwealth of Mass4chusetts Official Use only ` Department of Fire Services Permit No. Occupancy and Fee Checked F BOARD OF FIRE PREV TI � REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR RMIT TO PERFORM ELECTRICAL WORK All work to be performed in accor ane with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFATION) Date: 10/8/2004 City or Town of: North ndover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described bel,orww. Location (Street & Number) 946 Osgood Street X0,13to9 `t� Owner or Tenant NG Brothers Construction Telephone No. 617-338-0988 Owner's Address Is this permit in conjunction with a building 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: Installation of Fire System Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. ❑ 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 Initiating Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number I 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 Equivalent ❑ No. of Water Kms, Heaters No. o 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. 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: 8014.48 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: B & T Security & Safety LIC. NO.: 1599 C Licensee: John H. Beckwith Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-937-0555 Address: 18 North Maple Street, Woburn, MA 01801 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [:1owner Elowner's agent. Owner/Agent Telephone No. Si p PERMIT FEE: $ ��QQ S R Ib �1 ?(, ntttee lost 01.11-- The Commonwealth of Massachusetts ) -7 2A �. Dclwrimenf of Public Snfcfy' ocr.p.ct L rot C1.ee4a t:. HOARD OF FIRE PREVENTION nEGULATIONS 527 CMR 1200 3/90 114A.e L1...►) nL. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORI< All %ork to k perlormtd In aeeardenct ­dd�the Flattachusetu Electrlcal Code. 521 CFIR 12:00 (PLEASE M1Irr III INK OR TTiPE ALL IIIFORIMT1011) • Date. 11/22/95 City or Town of North Andover To the Inspector of Wrest Thi undeesigned applies for a permit to perform the electrical work described below. Location (Sfteet L Number) 946 Osgood Street o",er or Tenant China Blossom Restaurant Owner's Address • Same Is this permit in conjunction with a building permits Yes ❑ Ito ® (Check Appro riate.Box) purpose of Ruildtng Restaurant Utility Authorization 110. Existing Service Amps / Volts Overhead ❑ UndErd ❑ No. of lk ters__ New ServIce Amps /: Volts Overhead ❑ Undgrd ❑ Ito. of Ileters Ikwber of Feeders and Ampacity hot water.heaterlacement d irere Leeation ttrad Nature of Proposed ieleetrieal Work WA , No. of Lighting Outlets o. of Hot Tubs o, of Transformers Tots KVA No. of Littating Fixtures Swimming Pool Above In- grnd. ❑ grad. ❑ Generators KVA No. of Receptacle Outlets Ito. of OL1 Burners Ito. of Emergency Lighting Battery Unita No. of Snitch Outlets No. of Cas Burners FIRE ALAPHS No. of Zones Ito. of Detection and Initiating Devices Ito. of Sounding Devices Ito. of Self Containe Detectlon/Sounding devices HuicipNo. Local ❑ Con nnectI on[]]c tOther No. of Range i t Total No. of Alr Cond. tons Ito. of Disposals No. of eats Total Total Tons KW Ito. of Disibwashers Space/Area Beating KW of Dryers Heating Devices KW Ito. of Nster heaters KWNo, of No. of Signs Ballasts Low Voltage poring No. Hydra Massage Tubs No. 6f Ibtors Total IIP OTUERs INSURANCECOVERACEt pursuant .to the requirements of Itassachusetts General Lads I have it teatrrent Lisbilit Insurance Policy including Completed Operations Coverage oc tY substantial egttivaleat.. YF.S(j 110 I have submitted valid proof of some to this office. YES( Ito (] It you have checked YES, please Indicate the type of coverage by checking the appropriate box. INSURANCE 13 BOND ❑ OI11ER ❑ (Please SpecLfy) ' I xn rat on ate Estimated 'Value of Electrical Work S ` Work to Start 11/22/95 Inspection Date Requestedt eit,ed miler the penalties of 1•et j_•ryt rim KAIE Landers Electrical Co., Inc. Rough Final 11/22/95 i vincent; ts. 1ianaers, Pres. Y l.ltensee Signature C- t,Ll L AddressIUUU OsgoodSt., No. Andover, MA C�1b� Bus. Tel. too.' Alt. Tel. Ito. 011HERIS ZMSURAIICE WAIVERI I am aware that the Licensee does not have the Insurance cov stantlall equivalent as required by Ilasanchusetts Genrsi Law es, sn9tltat try 9Ignsture on application valves this requirement. Owner Agent (Please check one) 1C. Ito. A5912 Ia. 110. A5912 508-687 — ge or its s Is permit i Telephone No. _' PERMIT FEE S Sgtnatu" of Owner or gent TD 27910 r. NORTH ,SgACHU Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that &&........................................... has permission to perform W ..... #W . ......( W. ...................... wiring in the building of .................................. ...................... North Andover, Mass. e/,S ... : ....... Lic.NokS91.............................................................. ELECTRICAL INSPECTOR 11/30/95 11:301 5 '00 - MR. PINK: Treasurer GOLD: File WHITE: Applicant CANARY: Building Date.. 0 NORTIi °ft"`°:•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ................... �� , ............................................... has permission to perform f j wiring in the building of.... .... `.!...`.!.../.;, .%!�%`. ..� .. .... !. .... ry �i� �, at....................... ............ ........................ .............. .4, North Andover, Mas �........ Lic. No!..... ! .. Y ;ree .�s.. ... � . .............. ....�l�z r�-,:...... .. ....... ELECTRICAL INSPECEOR Check # 4 3;1 T1NC0MM0NWE4L7H0FM4MCHUSE77N DEPARTAMW OFPUBLICSAFEU BOARD OFFIREPREVEM70NREGUTATIOII iS S27CMR 12:00 Office Use only Permit No. //� Occupancy Fees Checked APPLICATIONFOR PI RMlT TO PERFORMELECTRICAL ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) E Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Q S Owner or Tenant 7 L A4 Owner's Address /,9 'f' / -Q < Is this permit in conjunction with a building permit: Yeses No [3' (Check Appropriate Box) Purpose of Building Utility Existing Service Amps /_ Volts Overhead Underground New Service Amps / Volts Overhead Underground Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work E � 77 6 7-7 the Inspector op'Wires: No. No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. 01Lighting Fixtures Swimming Pool Above Below Generators KVA . ground 0 ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units 1 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 P s Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipa Connectins Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No: of Si Bailasis No. I'.Odro Massage Tubs No. of Motors Total HP w hisu-atoeCa�aag� Ptisl3aib�tetegtritana�ckhfa�sacit�lsGe�x�+s � ltmeaamtlnbtTdyh�ser&=PohLYaldngCagA& CoIa WcrilssitlswWeWvaiat YES o NO Ihx6ewbmWdvalidpoofof=nebtheOSloa YES If}auha%edteiWYES,pleaseittkteitt Mxcfo maWbydeckirtgt r IlqSURANCE 1 !/ 1 BOND OUiER (PlmeSPe* E&i*dvakxCfF7eCftWW0k$ WctktoSlatt hsI>ae mD*Regix*d RcLo FmW FIRMNAME I3oaseNa Limnsee �= -,,o t�7� Sigl� v '. _ S Limnsel b Ll 4kf l/ --**1.l - e*�e OWNER'SPSU�C RANKEWAIV ;IamawmdvttheLkeme aodtiratmysamtaeonthsp=*Tpkabonwai% sdisteclttasncm (Please check one) Owner Agent ZBtsrt�essTel Na 4:;z Q�Q AltTeLNa Telephone No. PERMIT htseft Cmed Laws The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print W -MMM I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address City: Phone #- r Insurance. Co. Poficv Company name: , Address City: phone#• Failure to secure coverage as required. under Section 25A or MGL 152 can lead to the imposition of airnirral penalties ofafine UP to tt,sao.00 andforoneyears'imprisoment.as_*m[Las_civr7.penaltiessin-thelam -afAM]I,*YjEORICtsaW_afnesiA,ilAi W)_aj*WAgainstme I understand that a copy of this statement may be forwarded to the Office of trnesfigabons of the DIA for coverage verification. /do hereby cer der the pains and penalties of perjury that the informa . Provided above is due and correct. I Signature —�%� I pate Print name P.hons.# Official use only do not wale in this area to be completed by city or town official City or Town Permit�,,, 0 Building Dept []Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone # D Health Department O Other N°- 4.% _0 AV Date.: :......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING `.:.�.�....E� �t This certifies that ..�.:`. �• has permission to perform .... r .''.<.'. 1 ...... • • • • • • plumbing in the buildings of ...... at. ................North Andover, Mass. f Fee. Lic. No... ... ...... .......-''r?� v...... . PLUMBING INSPECTOR Check # � 1 ` � WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN(; (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 9446 O S Q dd d S -f' Owners Name Cl cA d `� P G Date 7 Permit (Print or type) Check one: Certificate Installing Company Name W� / f e- Pock- PlU tx 6mel SF1egi� ('�j Corp. je 6 09 C Address g d K 7?8 ISIO. Ai nd 0 V en M O. 1 /❑V Parhner Business Telephone q7,# q? -6 a, Z q 9 Firm/Co. Name of.Licensed Plumber. -F-d b e` t + 13. 4 (q.nCA ('+-F %` - Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy IE Other type of indemnity F-1Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance 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 fi this a plication will be in compliance with all pertinent provisions of the Massach4im stage Plumbing Code Chapter 1 of eral Laws. By: 110— 2LU=L-L 3 Ignaull u 01 Licensedum 5er Title Type of Plumbing License City/Town icense um er Master Joumeyman p APPROVED (OFFICE USE ONLYET Date. ...... e- ' N°- 1. ;%u NORTH TOWN OF NORTH ANDOVER J, 3j+w `•-• OL PERMIT FOR PLUMBING / •O+. r,o A �7 ,SSAC14 This certifies that .. �,*. .�. �..../. ! 4. �..G.... . has permission to perform ............... . plumbing in the buildings of ...� `�.� '...1� ` ................. at .. ............... . North Andover, Mass. Fee. ? ...� . Lic. No....... `....... ......... . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO P-LUM13ING (Type or print) NORTHANDOV/ER, MASSACHUSETTS / Date Building Location [ ��o � S 4 a0 � � Owners Name G�2 !�� d (31a5so tti► Permit # T e of Occupanc Amount New Renovation Replacement El Plans Submitted Yes D No ❑ FIXTURES r I hereby certify that all of the details and information I have submitted (or entered) in above application are true and ccurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issuedf this application will be in compliance with all pertinent provisions of the Ma sac#etts .jtate P�mbing Codejnd Chapter lZof thej�leneral Haws. City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License Cgs q1 Icense um er Master Journeyman ❑ ��a��� ..• mOMva MMM � • • • / 1 r. 1 • 1 1 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and ccurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issuedf this application will be in compliance with all pertinent provisions of the Ma sac#etts .jtate P�mbing Codejnd Chapter lZof thej�leneral Haws. City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License Cgs q1 Icense um er Master Journeyman ❑ s , if kation � No. y?S Date MORTh TOWN OF NORTH ANDOVER 16. 9 Certificate of Occupancy $ • ; ; Building/Frame Permit Fee $—� �ss+cNuSE� Foundation Perm�i-uFee $ 4 -o Other Permit Feb $ ,Z `10 Sewer Connection Fee $ " �= Water Connection Fee $ �� -2 Building Inspector ! 6637 l ` Div. Public Works N O w Z < 1 1 ¢ o LL Z O i a Z 0 H 'IO � W 0 f ( Cz0 W LLO u < N J Oj Z O < a 0f aI W d < d Z O Z O Z O m LL 0 0 W -- m z_ J < m z � Y w � a � 0 ~ A 0 z Z O U U M O m m 0 O r i cl 6 K L W �u p V Qr Ww I-� s� © 0 p �\ 0 uu uu °u z z LL i 4 u m u < Z z W N \ F m NI L W N \ A J F W F W F W F 6 O a p m 0 IL Z 0 _ q i w N K O A j OLL XIr N S Z zuu <` N W N Z m Z W m 0 Z ul i C O f 0 10 0Z O w m H J F u m 0 ° W m d _ p p j m m W m 0 LL 0 LL ZLO 0 fa J J z w 0 U 0 �! LL 0 Z U w O LL 0 f O z m W a W u LL K < w 10 w N z w' < ccr LL d d Z m 0 - y O ID 0 � V! X �m 2 .1 0 � �IZ O oZz Imw 0m w w C C v NE w < N w¢ Z f Z i Z <LL 0 m A u H W W K u W u a U z z S O Z U ? .N �O m o 0 a to rc W O rc z 0 F 0 z D 0 LL LL 0 F I W I x a z 0 0 LL LL 0 W N m W W Z E x u LL 0 J wW f O w Z < 1 1 ¢ o LL Z O i a Z 0 H 'IO � W 0 f ( Cz0 W LLO u < N J Oj Z O < J < 0 Z W d < O Z O Z O Z O m LL 0 0 W m m m J < m z 1 1 'IO � $ Z O z 0 z w � a 0 ~ z Z O U U M O m 0 O r cl 6 K L W j u WL p V Qr Ww I-� z 0 p �\ 0 uu uu °u z z LL d 4 u m u < Z z W \ F m NI i \ A J F W F W F W F 6 O a p m 0 'IO � w � a ~ z O U U 0 O r j u WL p V W m W Z C �\ N Z o J z z LL 0 F U m 0 w < z W LL 0 F m NI i 0 o p m 0 Z _ q i w N K O A j OLL d S Z zuu <` N Z m Z W m 0 Z (� O O f > < O u m u tl!w w ry J- W cn p 0 O �p Itw U' 14XW m LL ZLO fa J J J J_ w O 0 0 W �! ~LL LL U w IK , m W a W u u m LL < z W < W ~ f V m LL d W z <�� LL LL . > -; 0 O OD DO NID 0 -HOAAH 00 Zc y N m Oa A D I0 A w A is 00 D �c; D lNzO ~ O nTx I xAZ D N; 0 DA D ZZAZZ00O 00 ,8 ~ N xaA 0 i-nAmZ mm D;y Z N Zm n zx A OT ;DZDoD ,-; Z_OZ0E, O p ZG1 Z 3: y � 7iO O c = 5! { D <T 3: D zmZZO re Z 0 a Z n _ N I�Tf I III ! 1 1 LL 1 I 1 1 1 1 �� I 1_ n c Z{ o c= A D p v_ Z' Iw W O T N O D7 zmoocAD 0 - n r D Z N D A O 2W, . O T D O v T •r T -. ; T O NZ7C D O D rm f D O D _ D�^ O C D ti ~_ D N n x O D AO n D O A Z _ ID � v T T_ A T Z T_ Z x T A ~ x Z O C F; n To r O O T v x D T T x A -1 O O T C A S S C x m p v D m Z` "4 < T (�� F) F Z -yn Z D~Z~ y x A x� O pOZ 0 z 0 T x;ZAf1 O JOS T tiA T ��p rZ0 T ZD ti� DA< NN Jn 0 A -i � 0 ~ A S A X< Z Z �� x r F 9' N D is Z N OA DZ T G'Ix TN C up fl AD 0 v T Z " N X Z Z a "z$ ij 0 Z T A Z A ►�IIIN I III= I I IHd I I I ! I I �Om N NrN Zm DO yZZ �COX c �X-1 D n 0 10 En D* m 3.m -1ZD INn moo �Z_ mom v0m 5�N C ma0 �- `°_m F v rroO m -ic)r Z Tog D*D m ?�Z n xo 0 0� �v v nz I Nm 00 D0 3 tits � Maclaren Construction Services 88 Central St. Andover, MA 01810 Mr. and Ms. Yee 10/15/93 China Blossom Restaurant, Inc. 945 Osgood St. North Andover, Mass. 01845 Re: Restaurant Reroofing Dear Mr. and Ms. Yee: This letter will confirm our agreement. I will provide all labor, material and equipment as required to install the follow- ing roofing systems: 1.) Modified Bitumen: On the flat roof over the kitchen area only. 2.) Rubber Roof: Mechanilly fastened over all other flat roof areas. 3.) Shingles: On pitched roofs from the main ridge line to the of back the restaurant only. 4.) All roofing work shall be guaranteed to be water tight for a period of ten years. 5.) Any minor work required to complete the roofing work in a safe and professional manner is included. The above work will be performed on a cost basis with an allowance for overhead and profit. of 15%. Estimated total bill is between $25,000. and $29,000. If this differs from your understanding, please let me know. A G R E E D China Blossom Restaurant, Inc. Maclaren Construction Services off 1 51993 • ., t.., ,..''\.. , . .\'if> ;ri^ `�1x` � _"-�f�tt=.ii;Y-"'2't?i`. :,�l c.�'+t`;;:;`.'.r a1 .7 .. _ � .i:�,�` �'�': �' .. ' . ow STgi /� qTF iS• . ��.. *4O,S 7995 ss .� .� Sr°14? &, 0 0 4� :y ��q°? 02� �4p� FPp, �sl,� <41 co 4,99 Q� 44 ' 'yi 4br�'9Ci �� Q9 hG N % C 74 44 GFGi <� �, aT M�3T 9S r"MpF41 " Nis q Wy gSoy eF GR. SiGNFo ACV qF o� F S�Gyq���oF FNSFF C X20 �. 004% q 0" Fq �ti• . w 1 51993 n n r w (D `-° y n p Z z z tz -X a0i� w < z t" y a H CA TI p r" c� cn y C d o G QQ x o G a pa b7 C z O c r) C/) C r o O Cl.. x rD O o Oil x 'TI 'v O r C) Z CO! T CCD O 'v d CO) a� -o O o CD CD *NCO fl. Cr CD CD o CSD m C) c D m < CD fl. v y� y CG M z o CD• z — O v o Z M CD T O z D CCD O 0 /• C c ? = o o, 2 O N O CS y CCo CO) -0 E o CD n C CO CD �. Coi Z =r-Oy o, '= m o. =r C.� c. = m CD "'� O CD y O G CD OCD Wt _ C Co"f 03 Oo CA OD CD CO) rn n CL r� ca o �� V / D CD y (� to 7 C)= ^ o `) o ...r y O _ �yR :� CO) d 9 : CS o cc a CL ~ CA CDCD r^ E I _ CO v J y y�� _ ;• n -v CD co d co,D �_ •a CD cc � O �c') Z CD a IN CD ~ �' 1 s: C rr ^^ CD aVJ CD r� p CD r CD. go � �� CD o;: z: ys: O = tv •s rm v cn O rD d cn rD o w (D `-° y w o G QQ a z tz -X a0i� w < o G W t" y a H �? v o G OQ x r" c� cn y � y n o G QQ x o G a pa b7 C z O c r) C/) C r o O Cl.. x rD O o Oil x 0 cn m DO D m DO T z D r m z m D w w <�.f Z z y C z � T n y PTJ CO) 'v C � n x T � yCD C'7 O c� Z CA CSD O O a C'). O � i Q �• CO) o C-) v CD co o O a� C COO CD CD zw w CD ER Vi m < Qv y o C z �O CO) � 'O O Z C7CD.--r O o o z D C CD r C C13 5-0 d i CD —•v,0a H d O CD .a V± CD CD C7 mc�a� m Z y' =r -C N• et CD G T m aCDC03 CIO � O CD H p O W � n G x COQ -� O O .� n p cc CA Co °D _ Cr7 n n o �G VJ CDC CD O y • CDD 3 : A CA job CA C7 Cti ' O , W : O. CL �• %� ? HUCD it o is 0 CC C3 O CD D 0 `° i CD CA CD r CCD : • a�• CD z c CD M O eD » ff 'II 0 c w w <�.f N C y C O T n y PTJ OQQ aq n x O_ r r O a COO x 'II 0 c Location 746 57?1C�7' No. 'x,253 Date 1.//2,/16 TOWN OF NORTH ANDOVER CNI:z'A-�,SIII 06/13/ 83g6 dv TOTAL $ — Building pector 33.00 PAID Div. Public Works A Certificate of Occupancy $ • Building/Frame Permit Fee $ 33 s "'^" E Foundation Permit Fee J�cHus t $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ CNI:z'A-�,SIII 06/13/ 83g6 dv TOTAL $ — Building pector 33.00 PAID Div. Public Works ��� Roe ;>� ��� ���>x �:.�:.: � . �► � . ��, � ��, � .. 2 n n O. ... O O n z z Z m n m m %b :Nk � ) C 14 ° � 6 O O � w Q 0 m mm m N - O w r x r r O 0 c -C1 w m m -n1 -4 z z a a N 2 ul M c n 0 z N A e t . i A m 1 m zz > c a 1 Q A > 4 r_ 0 A A f O r 1 1 J 1 Il, x z t I.7 N > c x t 7 _ � � O� A N 0 1 1 1 n m z a � c i c = O 2 n n O. ... O O n z z Z m n m m %b :Nk � ) C 14 ° � 6 O O � w Q 0 m mm m N - O w r x r r O 0 c -C1 w m m -n1 -4 z z a a N 2 ul M c n 0 z N A a x � N > w O O It .> O O O> 10 > z N m > m 1 z S c i 2 = O rr, 0 O n A 0 v°ry Q n '� 7 � o� Q n $ 7 A r° Q n 1 n m .� 0 m r I z z 0 m r r r 0 z ttt z z O -4 A O c o 0 o r n n n A > ui Z c h -1 M m A w i 0 `l > 0 Q Q Q ZI a a x m N > OyI O O It .> O O O> 10 > z N m > m 0 0 7O0 -� S c 2 = A rr, 4 m m C C m C > ; F. > > r I z z 0 m r r r 0 z ttt z z O -4 A O c o 0 o r n n n A A ui Z c h lA H M m A w i > `l > 0 Q Q Q 0 v A m A i 0 a 0> I I Z>> Q I Z m O O I > O; i m r O A x i m I z m A r n la 0 F r w > m i w 1p ZA w q 0 -I A m w W > A A j A O 2 r 1 M O 0 Z z m c ? O � a 0 z O 1 Q <_ O 9 I m � A'8 ; x .,� z o , m aZ �1 u►r c 0 IJ r of z > D 0 Q rz O 70 70 3 O C2 c Z O a x N O ww m > m N A m Q m 10 > z N m > m 0 0 7O0 -� S c 2 = r0 I > 4 1 a m I m F -q 0O O n w -z1 i CI ,� 2 m I a 0 0 -1 0 to O X J A n ;zQ;oar Z c h lA H z a m� I i O m w a A I I Z I m w I i a I -1 A'8 ; x .,� z o , m aZ �1 u►r c 0 IJ r of z > D 0 Q rz O 70 70 3 O C2 c Z O C j 4 N 1 A b z N m 0 A O 0 0 7O0 -� w c O = r0 > m Z z z Q 0 O n < m 2 m ?o m to 3 X lA H r Q > p m F j 4 2 0 I N Ip N O r z A x i z O > m n X z m w W O 0 � z O � O 9 m � s �� r �.,IIIII 0(3 ^Illilll t m� LL.vi � WW u IIIIIIII�I Z c am �o a �I O u Q W Q °C 0Na C7 101- WZo Z ooa N D Z=N .� OmU , N W ea W 0 p. 1Nw Z UNI <ZF- W1W 3oN =T�1-f Lmu �W 8Z F-X� NWW IL �zD Z. V) 0 U p(nu UW WZ . NJW N N 10< 0< m 1 �� �.,IIIII ���� ^Illilll I � IIIIIIII�I IIIIIiii�� TI TIT ��IITI� =T�1-f �W 8Z Z ; x Z L a - p I I I Z O TTTO _Z a 7 �� Z< io nQ x nW Y z;LLQ� s w of O O Z W d oc W o w K OV K N px V O H Z W U Q V Z _� �[ W U - I>Z 3 W O N Q _ i maa �� V�oS x Oj 0 �� Z�oQx W W W K W O J Q O 7 m iaa� Z 22x0 Of OaaO� (. I?o Oa�_pal0�_ 3 Y Z N r .- a0 d N O <Z S Q oc O V _W O O W Z N O 6 S o O 7 LL V w x V< Q .n Q^ '- 0 0 U 0 u 0 UON �Z ocp C xf HW p0V O c.r z , O V :ELL F W = 2 > LL r Q Z m u w, O p oep Z_ x'^,n000Z H W V Zoe ZZ � F --o V VYH �� Q 1 0 m0 a- 2dO2��O0 � O n o o p 0 YUZZ 0 0 z � W mF=OW-0'' �N C� N � � 0 0 m pp N Z ZuW M w s �pp> 000 In <QQNO��p {0 0 Ija Q 00. OQ> V'v�tum���-e m m V N N V W Q 3 N a r h m v C •C CACD n Cl) CO)Z D O 'C a. r 0 CO .f. d CO) O CD CCD O C cu CD CD o CD _ v� o0 a C O V!. CD d 0 y �= C=D I � v CO) O Z O O o CD 0 c CD c �-o p = _2 N O or N n p C W N d 0 W n C co') CL 3 Z ?-o N i d CD = T CD O O p CO) O W N p �m= Np O O � C W O m `I N p C/) CD p �?�- C m N W N r H� C a m ' _ ,� d m 3 CO) .= ' O w N ay#� r.� ,� a �]] N CD C N CA CD W CD so CAC r* _ CRD M--�:o - O O O o t CDa. O Tye �1 Wp .« . :+ N CD oa �; o r: = W d • o, � ts..at . t77 : C O o ff � rc 1 z a' a �, z0 rz I °_CD o � T w C < � o oda �- � -3z t z Ix w z � 7 -P w n a' 5 �, � a o � r �C� C ^ n N o n g r o a H 0 0 c f OFFICES OF: �TOWii• ofa-120 MainSU'Ce -.--- APFF-A.Ls .t •y; NORTH ANDOVER .-North Andover. BUILDING �`y�e Massachusetts%c8-zs CONSERVATION DIVISION OF HE -\LTH PI-ANNING PLANNING & COMMUNITY DEVELOPMENT 4 KARF- H -P- `ELSO`, DIRECTOR In 1c:.^.rdance wi(il (he iiC: Sri. �S ^ S . 3 condn :^it itioe[ Building Pe: Number ,2 S3 s^ ;`c( ^. de :a resulting Froin this work shall be disnosed cf ... a prone: - !--czrte;.- solid - ^c: by ti1GL, c il:. S :50:;. The debris will be dispeset! cf in_ Sce:.a(::e ai Pc: ma Aooiicnt Date NOT=: Demolition permit fry the Tow3 of North Andover must be obtained for this project through the Office of the Building Inspector. Date.. . ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING I — This ceimifies that ........ —7. t4 ... C ....................... has permission to perform .......... ........... a ...q.4.1 ....................................... wiring in the building of ........ . ........... ... / e) ..................................... ...................... North d at ....... . 1.%X ...... . .. .............. Andover s. . . ....... Fee. Lic. No'/ APV ....... ............ Check # >;ELEC' WRICAL INSPECTOR 5424 �anu�snawaa o ct�a /ttc�aEf3 Official Use Only c� Permit No. �� 1Ja�rarlrrur:t` a�_ytrs �arricas — �,. - BOARD OF FIRE PREVENTION R D TIONS i `Jccup; ncy and Fre Checked ' t f�2ev1 Il9ij r t i . ficave blank) 1 APPLICATION FOR PERI IIT T �ERFORM ELECTRICAL. WORK Ali work to be p rforn:cu in accordance with dic M-issachuszts Eiectrical Cork (M ). 527 C1lR 12.110 ,t'����sr-lu'r'VTI:v t:val� rrl�c.tLL IrYi='QIZiI ITIt7r1 Irate: g ze✓' uy City or Town of: Itl�To Lhe In— By SI -Ta -07-0j, lay this application tt:e uttdersigueuicc ns 11is or her intention to per farm the electrical work described bP1Crv. Locntiuu (Street & i\utnbcr) 9y69 r7,T,,,, l Owner orTenant ��tlt�a.�r U CS � Telephone No. Owner's Address is this pertrrit ill Conjunction with a building wrmil? Yes Lr l No ❑ (Check Appropriate Box) J, 1 urliose of i3uzldtr:g �rnirtvGir Utility Authoriratio❑ No. Existing Service Af1117S 'Volts Ovancc2d k!a" Undgrd No. of Receptacle Outlets0 Near• Service nett} s I -Volts 0- enccad E] Undgrd tial i. of terns Burners Number of Feeders and Anipac;ty Location ai-d Nature of Proposed Electrical Work: No, of lleters No. of-VIvers. ili No. ottRecessed Fixtures ��p No. of Lighidiig Outlets Na. of Ceii: Sus Paddtel, Furs P ( ITransformer No. of riot Tubs 'Generators t o• o ota s 1{Vr1 KVA �- No. of LiQlrti;:a Futures b Ayre ❑ L�- ❑ S�viwntin Pool g rnr?,r;td_ ! o. o inergeticyLighting Batten- Units No. of Receptacle Outlets0 No. of Oil Burners FIRE ALARINIS No. of Zones 44 No. of S74itcltes y tial i. of terns Burners t o. o etecUcn and initiating- Devices otni No. of Ranges No. of Air Cund. .Foss eat Pump I tum er . ons Ii�V ,,o. of Waste Disposers Totals: 1,- _ _ is jNoo. of Dish -washers pace!Area Heating KXV No. of Alerting Devices No. o Self -Contained DeteetioiVAlerting, Devices Local C]Coime tion C1 Other No. of Dryers Heating, Appliances K,; Security ys#enu: . No. of Devices or Equivalent i a. at seer "- -- ,tie. oE�- No. of >;at:i llririt2 Fle•it�s I'�y Ballasts _ - Stens _ No, of Devices or Equivaie:tt No. Hvdroina.ssage B2tlstubs INc.. of iilotors Total 11F E'1'c ecantmunieations�Yiring: 1 No, of Devices or Etluivalent OTHER: i ' attach add ti3fra; rietaif tJ desiret<, or as reruired by ahe bispector oj iY i, es. INSURANCE COVERAGE: Unless . aived by tl a owner, no permit for the performance of electrical wors may issue unless the licensee provirus proof of iiabiiity insurance including "corr.pIete'd operation' coverage or its substantial equivalent. The undersigned certiries that such eovernge is fn force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER Fj (SPecifT) (Expiration Date) Estiniated Ni a;ue of Eicctrical Work: 23 SSD, (When required by municipal policy,) Wart: io S --.art: tV Inspections to be requested in accordance with MEC Ruse 10, and upon completion. I certify, under i& pants artrl perraltirs afperjur}r t!iut die infer rmatdon ort this application is trice and complete. FRUNI NAME. Arel LiC. NO.:_1723aA__ Licensee: Richard J. Arel Signature LIC. No.: 27514E ((fapplicabte, errrr '"etcv,ga. ra rhe ticNrii^ rlwrthe: time,} Bus. Tei. iVo.• 978-372-1601 Address:,- 773 WaShi ngt-rin -g reef- 14auer1ti I I MA 018-19-4, 49-1 Alt. Tei. No.:`187 OWNER'S iNSURANCE WAIVER:: ani aware dent the License'.- dors not have the iiabiiity insurance coverage normal.1 required by la-j3v rl:v signature below, I hereby waive this requirerne::t. I am the (check one) [7 o vnr* n ^ •^'^. ' "` ' �C�/ Location No. 23 i Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ . Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ .Mater Connection Fee T. 1 19930TAL o e 4, 5_7� Building Inspector Div. Public Works Location No. I Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Nater Connection Fee $ 4 OTAL $ Building Inspector Div. Public Works W (7 i I W 0 a. (WL p Z a z In �o i V m A 0 0 z Z 4� m r W Z J ed z N z ° C o i N Wor N N m W r uv X a a d 0 r m 0 N W Z N J f'' 3 ^ lz c Z Q IL 0 < z o J r i < m i _ O° OIx i< m a W ° a f m ° r 0 :w Z W LL N 4 m 0 W E W IL '0 I D N m 7 d O z < m W N a m 0 0 J ] I+ W Z O H z 0 J J J m F O< i u Irll ( N . J d m J I M 0 0 s < N m N 3 m O H w 0 Z d i (')o � GL Q 0 © 4 z 0 0 r z YV �.•' m _W cr i Wz Z O W Y < jr < 0 z 0 A < F p O r a W Z < U 0 N Ir W z N m W F z u E� N O 10 1< w WI a 0 CL a � m x z L N N m W 0 m z O r 0 z D 0 LL LL 0 r x r, W Z W f �I W O a r z 0 m LL x I W Z I u LL 0 J < wW < i z og (7 0 W 0 i W Z a z In �o i V m LL J z Z 4� m r W Z J ed Z z ° C o i N m W r 0 d 0 r m 0 N W W N J f'' 3 0 U < < z z 0 0 p 0 i< (c°�� 0 Z a Z 0 LL LL O 0 O Z 0 z t7 z p < m W U W U W U LL 0 0 0 J ] LL 0 W Z Z z 0 J J J m 0 i u Irll N N W m m m J < M 0 0 0 < N m N 3 m z og 0 i 0 �o i V z 4� f N m Z i N d A W W 0 N r Fd O z O IX u z C � LW L L p 0 (00J 0 (c°�� 0 d W u m m m u A z < F: W F: W I- W M a N i 0 i V 4� f N Z i N A W LU Z z C O O r r y W W 2 Z N m � Oc�>cQj N p 0 0 1 1 I m 0 J J_ i u F LL _ LL � 0 N ` 1 W d m W W L I I m z W < < w d d i s W • L j 0 r 4� W LU 2 Z Oc�>cQj 1 I m 0 i u 1 W d I I m z � Z © I I J r z (� m W I m 0 } ~ a 0 CL m x < O 1 J z ir. W0 W @. m LL r Ca cum w I N < j W m _J { w d0� m IL d i- — 1^ _ �f, -m �N-1 ; * 0 Ch A 5 NSD D OvD „pp pl In 00znn O m my m Amc 0 A A r pOOD mD mmpA O n�c nm Dp INmjZ C3D;< rO mmn,,,n.2Om- P 0 An Ati O 0 O C)r = N ZZA0z0 Z 0 p.N ' 0 AZ; O O Tz AP A; Z N ZO N C NmzD 0 OD N 0yD 0DN� > 3 r Z O, p3„0 z Z O O Z N o C1 0 ILII Tf l I I I I I I I I I I I i I I I I 1 1 1 1 1 1 1_ JJ_LL 11111 I _ _ W Z T -0 Ap CA" T A D-1 Dr 0 to O D ZODZ W�wZyAs NON x -A1 Z p Zy D Z m T TNp yn x Sz3 A Z ZD O p O Ox 0/C O A T D ZN ~ � a D Iw ZD V T^ Z Q Z 1z, AAZ J-J—�-1I _ LI IIIA" I I Ilillll- I III !I I IIII � 0 0 0 D z 0 { SON N U) zm Im DO NZZ Coc �X-Nj 3nw 0�0 Nod p3m mx -azD Ion NOS �z_ MO3 �0Z N � Mwo 0 TSN Oioro'0 z "D ul 0 r. ?_z I'o 0-4 mD 0z i0 M . 00 D0 .3 r 10 ,1 I SQL V a m N N Z 00 O �°` 55N D 1 :f Z�iW D O 1 r" O� Z ; 1 a N tn,r D 0 0 0 i v a Z m = T Z i y - i %O W vii m o x an d 4 4 1 a m zzm N 0 0 � 2 A + i ooh ♦ � 00 zt ` =TZ` N F. n L O %0 r aooa 8 m n to 0 0 9 f Z—f" -,p m O p 0-M 0 0 a ♦ 0 Z Z O j o y OAZ t7 < N ; ; m. } i, i M -4>o T w3 �O m H o ' m m 3aa 00 Ne! N r c ar"n 00 Crrt -vz F m N..•�-1� ©via rnN r :OT y S Z oomm o c ; 0-bmz A z w m ^ o 0 N { o ; o Oo z� 1 11 WT fy r'—fm Z y a mo r . i 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: CA-11JA bLOSSota ?%�l Phone (P 82 2 Z d,7- LOCATION: ,2LOCATION: Assessor's Map Number IA. Parcel Subdivision Lot(s) 1-fi-reet OSGvoD SIRKMaE St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections driveway permit /Fire Department � Receive by Buil ing Inspecto Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected '�7 Date OFFICES OF: °m Town of 120 Main Street APPEALS NORTH ANDOVER North Andover. BUILDING ;'_ .� Massachusetts 01845 CONSERVATION ,t DIVISION OF (617) 685-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT r - KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number 931 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: �JPf4R.zAN G�NSO�ttpA�t`1� LVIA 600' "r1kVCK1g6) 1(00 QOGKIt4e.14KK �d Loi enri cgm!h( W.14, IF (Location of Facility) 11� .Lll, Signature of Permit Applicant 4 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 1 0 x O 0 W win ZJM L) Ln U W LJ �JW Of < CL !— A DETECTORS The detector consists of three basic components: the bracket, linkage, and fusible link. (Fusible links are not included and must be ordered separately.) The bracket holds the entire assembly to the mounting surface. The linkage is used to support the fusible link. The fusible link is designed to separate at a specific temperature and release the wire rope, thereby actuating the regulated release mechanism. There are two styles of detectors available. One Is the clip -on Style and the other Is the hinged style. The clip -on style allows the wire rope to be strung completely through the detection system conduit and brackets first and the detector linkage assemblies are then clipped on later. The hinged style detector requires the wire rope to be strung to the detector bracket, and then "threaded" through the linkage assembly before continuing to the next detector bracket. Each style of detector consists of two types of assemblies: The Terminal Detector (Part No. 56838 or 15376) includes a test link and is placed last in a series of detectors. This detector Is sometimes referred to as the end -of -line detector and is thus named because it Is at the point at which the wire rope ,ter- minates," or is anchored at the detector bracket. Only one ter- minal detector Is required per detection system. The Series Detector (Part No. 56837 or 18373) Is any detector located In -tine between the regulated release assembly and the terminal detector. There can be a maximum of 11 series detectors (Part No. 56837) or a maximum of 4 series detectors (Part No. 15373) in one detection system. PAIRT NO. 56637 AND 56838 6RAC1(ET A&9ilA6lY PART NO. 15373 AND 15375 Fus"M LINK EMBLY FIGURE 19 SECTION III SYSTEM COMPONENTS. UL EX. 3470 5.1.90 Page 3.7 PULLEY EL13OWS There are two types of pulley elbows used to change the direr. tion of the wire rope by SO'.. Part No. 16426 Is used in appitoa. tions where temperatures do not reach 200 °F (93 °C). Part No, 45771 is used in applications where temperatures reach 200 OF (93 °C) to 700 OF (371 °C). II:IIIi PART N0. 16428 PART NO. 45771 FIGURE 20 PULLEY TEE The Pulley Tee (Part No. 15342) is used to change the direction Of two wire ropes by 900. it must be used In areas where the temperatures are within the range of 32 OF to 130 OF (0 °C to 54 °C). Pulley tees can be used in mechanical gas valve actua. tion lines and remote manual pull station lines. Pulley tees cannot be used within a detection line. WiRE ROPE FIGURE 21 The wire rope is run from the terminal detector, through con• duit, all series detectors and pulley elbows, and Into the regu. lated release mechanism trip lever. When any fusible link separates, the tension on the wire rope is relaxed, and the trip lever actuates the regulated release mechanism. The wire rope can also be used for mechanical gas valves and remote manual Pull stations. The wire rope is available in 50 ft. 0 5 m) (Part No. 15821) and 500 ft. (152.4 m) (Part No. 79653) lengths. REMOTE MANUAL PULL STATION The remote manual pull station (Part No. 4835) Is required for manual actuation of the regulated release assembly. The remote manual pull station should be mounted at a point of egress and positioned at a height determined by the authority having juris. diction, FIGURE 22 SECTION III — SYSTEM COMPONENTS UL EX. 3470 5.1.90 Page 3.8 MECHANICAL GAS VALVE The mechanical gas valves are designed to shut off the flow of gas to the appliances upon actuation of the regulated release .assembly. The valves are available In sizes of 3/4 in., 1 In., 1 1/4 in., 1 1/2 in., and 2 in. Ansul style; and 2 1/2 In. and 3 in. Asco style. The valves are rated for natural and LP gas. Both styles are listed by UL, Inc. Pan Maximum No. Description `_ Operating Pressure 55598 56801 3/4 in. Gas Valve (ANSUL) 1 in. Das Valve (ANSUL) -10 psi (60 kpa) 55804 1 114 in. Gas Valve (ANSUL) 10 psi (89 kPa) 10 pal (69 kPa) 55,007 1 1/2 In, Gas Valve (ANSUL) 10 psi (69 kPa) 55610 28937 2 In. Gas Valve (ANSUL) 2 1/2 in. Gas Valve (ASCO) 10 psi (69 kPa) 5 psi (34.5 kPa) 25938 3 In. Gas Valve (ASCO) 5 psi (34.5 kPa) ELECTRICAL GAS VALVES rimuHE z3 The electrical gas valves are designed to shut off the flow of either natural or LP gas to the appliances upon actuation of the regulated release assembly, The valves are available In sizes of 3/4 in., 1 In., 1 1/2 In., 2 in., and 3 in.. The valve is held open by an energized solenoid and upon system actuation, the switch contacts in the regulated release assembly open, thus do - energizing the circuit to the gas valve solenoid, causing the valve to close. Valves are available In 120 VAC and are listed by UL, Inc. Part Maximum No. Description Operating Pressure 13707 314 in. Solenoid Gas Valve 2 psi (13.8 kPa) (ASCO) 13708 1 In. Solenoid Gas Valve 1 psi (6.9 kPa) (ASCO) 19709 1 112 In. Solenoid Gas Valve 25 psi (172 kPa) (ASCO) 13710 2 in. Solenoid Gas Valve 25 psi (172 kPa) (ASCO) 17643 3 in. Solenoid Gas Valve 5 psi (34.5 kPA) (ASCO) FIGURE 24 MANUAL RESET RELAYS The manual reset relay is required when using an electrical gas valve shut-off system. Atter the electric gas valve has closed, either due to system actuation or power failure, the valve can not be re -opened, allowing gas to flow, until the reset relay button is manually pressed, re -energizing the circuit: The reset relay Is available 120 VAC, The manual reset relay' is also recom• mended for electrical shut down, FIGURE 25 ELECTRICAL SWITCHES The electrical switches are intended for use with electric gas valves, alarms, contactors, lights, contractor supplied electric Power shut-off devices and other electrical devices that are designed to shut off or turn on when the system IS actuated. The switches are rated tar 15 amp 1/3 hp, 125 or 250 VAC, with 1/2 amp at 125 VDC and 114 amp at 250 VDC. The switches are available In SPDT (Part No. 15549), DPDT (Part No. 32222), and 4POT (Part No. 32220) models. FIGURE 26 M AVIIENDIXA 96-17 Roof --7'\ 3-8.2.6 Grosse duct a, To noncombustibles 7- To limited -combustible IS*, Clearance to combustible stiblesas union protected in accordrd ance with exception no. 2 at $. Exhaust hood 3-8.2.6 Hinged, up-diSCharge exhaust fan 40 - 1-3.2* Cr' To ninci�rnbustibles A 3" To limited -combustibles I 8�' Clearance to combustibles unless Protected In accordance with exception no. 2 or 3. Figure A-1.3 ''Typical section view for one-story building without fire rated roof-ccillng assembly. 1991 Edition "A' 01 (P { REMOVAL OF SMOKE :\ND GRE.-ViE•L\DEN VAPORS FROM COMMERCIAL COOhI\G F.QU11'.%IEN'1' 19`91 Edition 1 [_ 1 X �W Table A-1-2 Examples of Types of Construction Assemblies Containing Noncombustible, Limited -Combustible, and Combustible Materials Classification for determining hood and grease duct clearance 40�J ' Jy `C4 0v . � A � TYPE OF. WALL ,... ASSEMBLN....,.zsd :i20 4O �00. brick, clay tile, or concrete masonry products VI/ Plaster, ceramic or quarry Tile on brick, Clay tile or concrete masonry products •V/ Plaster on metal lath on metal studs gypsum board on metal studs / Y- solid gypsum board •' / V Plaster on wood lath or metal lath, on wood studs -,// gypsum board on wood studs r plywood or other wood sheathing on wood or metal studs ✓ : TYPE OF FLOOR -CEILING OR ' t, ROOFrCE1LIN9`ASSEMBLY r Plaster applied directly to underside of concrete stab suspended membrane ceiling a) with noncombustible mineral wool acoustical material 2� b) with combustible fibrous tile b)V gypsum board on steel joists, concrete slab gypsum board on wood joists / See clearance requirements in 1.3.2. Solid gypsum walls and partitions, `_' or 2 V4' thickness. are described in the Fire Retiolanre Deign Manual published by the Gypsum Association. Washington, DC. Note 1: ' Lyall assembly descriptions assume same facing material on both sides of studs. Note 2: Categories are not changed by use of fire retardant treated wood products. Nute 3: Categories are not changed by use of type X gypsum board. Note 4: See definitions of combustible. limited-cumbustible. and noncombustible in Section 1.2. Definitions. CO2 a z CD o CL r d o � O o p CL =T 03 CD 0 Qo CD CD 0 CO) C7' 0 c CA E C13 CD 0 CD CDa H CD CO2 0 O CD0 C CD � C CO �. y O. Q N d O C W .0 C/! O �� n m n H m co d C z =r-oco H .-. m aim o m m p m y 0 CO) N C:j =r CO i >CDo o -a S .. o zS.e, O O C � o o CL ..: � 0 3�: CD H CL �y m N O. w OCCL W- O O _ C .q to �„ :•! CC* :O m CD 3 O Co N OD O 7CD n ® O zCAo. t CD 3 �n CD CD :.► N mop c W w V3' if CD D2O c o • moo: Co cn C7 CD cCn p tr 'TJ ^n qo ?y cro 7i 110m n D n cn 91 %C y 0 0 c CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 231 Date JULY 220 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 945 OSGOOD STREET MAY BE OCCUPIED AS KITCHEN RENOVATIONS TO RESTAURANT IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. �q,1 °•,...• �ti° ERTIFIC TE ISSUED TO China Blossom Restaurant, Tnc. • °AL 945 Osgood S t . ADDRESS North ,JJACMUSBuilding Inspector � D m � z z v, CO) D 'D m C � — d rO Z y T CCD O 'v d d CO) MqO CD CDO 0. C7 =r CD CCD O CSD � Z m O < _ CL v CDm CO) c. m z o CD z - CO) v O -a CD CD O Z r CD tz C7 i Fagg »g g n H sci ci a� m Z ="rs_I o = ^: m H ac T gm o Mn CD m O gr y p y N p =CD _ > > CD G �p C.) :�•: O G H- C09 �om:�� CO) a � a CD co 1 O CO)P---4no c CL. CD A co,to N CL CS 1+� N OCD ,1" C N CA c :I ..0 p o al: W o N CD CD Co . n H ; Q CD10 d CL moo: O � CD m 0 c ST - Location No. Date µO"T" TOWN OF NORTH ANDOVER r 3?0. `t�ao :a,tiDOL p Certificate of Occupancy $ # • • Building/Frame Permit Fee $ )� • oma+ _ ' i 'ss�c►+usEt Foundation P ee $ ao Other Permit F $ Sewer Connection Fee $ Water Connection Fee $ cso TOTAL $ auild-ing Inspector 09/22/95 13:03 26.00 PAID 884-7 Div. Public Works W a Y 0 0 m W r ui #A d X to (K W yj > Z 0 g z Z U. 0 0 = o ' m m W O U 0 w W m I g 0 D N �A. z 0 rc M 0 z N r m m w W m Ir f F 0 0 LL LL 0 W N N 0 Z z 0 J 0 � J c � Z W < z W m O < W � Z N 1 j W f i z f 1 W z Q U 0 ir W z it W z Wt = C i w 0 j N N � i, m c a O z _0 r O z D 0 LL LL 0 r x 2 W I W a r z 0 rc LL r 0 J LL 0 iW im t 0 z 0 0 LL LL 0 W N W 3 W z 0 z_ 0 J m 4 W z E I u LL 0 J m W f V\ 0 fo z LL z O r u a N J W L L LL 0 O K a 0 m s 0ev = y" m � W W 0 V L L W Wr pr z 0 L O O O r� 0 U U W y L J L r C G< ~ ~ J bJ�(■(1�VJ1 LU L m 0!S m m m u WF H Z Z Z V h W W m 1 0 C) V Z N z 0 c D f f3� O W N � r Z_ F N N IK Q3 ^ ^ YI m L f f zz L 0 0 , u L uu m m � p 0 0 m J J F LL LL f 0 N m W W W 0 0 L m L L L f3� O W � r IK Q3 W f f + ,w IL L ti .• m V m 8 mp 1 3 001 A �ADOvDDD ti :E D m N N n ooznncC OOznnnnAar=00D> m m N N m D D NN O n A A = r Z- I0• D A W v m -'00 An n n z z N D 3 N ACIZ D -� Orp 0 O r y0��;m mm mm. 7Cnn y DOO vm Om D Nx nn Atir m D N 3 O AQ°r^OD O 0 A N� = N r Z Z A 0000 z Z 0 0 0 0+ '^ N= NO O A A3 O"\ 0^`m et m m % O m P N H _ Z m Z S �Z A3 n„ 3 z T;GIO z z N o z G)n z ON 3 p D ti m 0 C to 3 3 a� C An0OC) " 0 nG�N;= p Som;ODN D zCN � T Z n v <� 1_ N m D T T z A m z 3 0 r m O N N = O N < mr < T A N z {Z _ '^ m I I I LL n 0 �I TT I I I I I I I I I I I I I I I I I I I I I I i_ ALL I -LL-Li- I I z _ z�0G1CAD2m O^- rN D, D O p p O Am v -�-�3y r r o zA 0 n D < �-+m O D DN O O O D ti DnS N 3 A A n Z t0 � 0 rTr m z z CO V Svi Z D p z' .� C ON r S ti -Y O C; D � m(/�� mm T mm r A S y A y S m m O A _� n o S S v 2 A D m z` y C m ^ l 1 o n y n = Z T y Z y v (/ N O D O z 2 C z A A w D O mA y rZ0 m Z y -� 3 D A< O Z -Di=�A 0� Op T_CO m_N�O3X H �mnti m Q G% A- ti 0 ~ A i X C z z m r �_ a m �' D D 1t Z N ci OA z D A Z T 1 l .y -�„G�7c A �n� T C p A T n A„ D D I I I Iw A D v ^ Z N X G m Z I p Z Z O A I I I I IJ I I I I I-_�I�'1 ILII=J Z LILL IIIII" m I � III !III IIIIIIIW IIII � mr-i DO _x C)-1 m (mprm Zm Ami DO NZZ Cox C �X� D n 040 moi mim mX -izD xon moo ;aZ_ mom TOZ 'n m M 0 O—Z N Dr oo 11 -+c)r 000 r • -� DSD Z—Z -+ o xo o-4 �D nZ xn mm Om D0 3 m C v_ z 0 W cr ON 7-4 1 t plo W O c� o p O c v CD c N :oma m CD W U t O �' W • c ci v� N E Q w�w. C O-W.iw CD H CD c i :CD m z :cam :C,o V cm z ` z V - cCLCc- w ` a L l(( y 3 w O y C71 � m J N ri: V C a ca N O t� C co G m d o z od., CD �.� m o z a =Lo z u 4': w m (� V: � C.i V y O Z C rr cm Q ""u ` O c O = ~ m m_, o t -4a m H co w L_ O41 ti _N ar Z O LLJ m C.2 -0H oma -a �a -5 Z typ 'S O ti O O ►- aim Ts T DO DD O aJ m = C cb O C W DO O G to p C C y O u. vO cn w ; a: U w ix. pG y'rj cn i% iz W cis cn plo W O z 0 V lei I C" C) cm W L O O v+ Z Cr O y C co cm CDC cn U •F m m co O i CD O CDL � � Q y C Q_•+ C Ccqo v J -='m O a, C co V CD CL GO •� C cm is\ - z 0 Q cc W UJB z 0 U W J Q z lr LU Q LU w c� o m c c v CD c N :oma m CD C3 V : a C • c ci v� N E Q C CD H CD c i :CD m :cam :C,o V cm 17- ` V - cCLCc- ` L l(( y 3 y L .-. y C71 � m J N ri: C ca N O O C co G m o 0 CD �.� m a =Lo 4': H m (� V: � C.i V y O Z i O a cm Q i� ` O c O = ~ m m_, o t -4a m H co w L_ ti _N ar Z O LLJ m C.2 -0H oma -a �a -5 Z typ 'S O ti O O ►- aim z 0 V lei I C" C) cm W L O O v+ Z Cr O y C co cm CDC cn U •F m m co O i CD O CDL � � Q y C Q_•+ C Ccqo v J -='m O a, C co V CD CL GO •� C cm is\ - z 0 Q cc W UJB z 0 U W J Q z lr LU Q LU w s ZEBTo 'au `11IN?'3�rN MNOISSIWV#= } WOO 3SaN3 31d331S 96Z 83IN10rS d SONII _ = . 00 :01 paTatlasaK MON AUIPJ Z I T - 9T WIM/ZD 966T/iT/ZO ESZSIO S3- 6jUO A100"N - VT :ajppgljls :saltdz3 :laganK a40K - 00 - 3SK33I1 80SI883d05 NOIi30818NO3 00 .01 paTauTsaa 1131VS 3I180d 30 1K3N13ad30 � Qv �oJf MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI>~I�� Y� S (Print or Type) NORTH ANDOVER Mass. Date _ Building Location 9r(s OS5aoPermit # /,),3a Owners Name CL-,& (3,10 S 5 0. , 12C.Sf .Tf e. • New '1 Renovation Replacement Plans Submitted �] FIXTUP=c (Print or Type) Check one: Certificate Installing Company Name WaJ/ �vu 13i/`r i -tri Q Corp. Address P.d, �/ o - Partner. Firm/Co. Business Telephone: 6/7 -0 qy-3 30_ / Name of Licensed Plumber or Gas Fitter GSc J, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [�!] Other type of indemnity Q Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent 0 I heteby 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 undo; Permit iuLrd fo: this application will be In compliance with ad pertinent provisions of tho Massachusetts State Cas Code and Chapter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE use ONLY) TYPE LICENSE: Plumber Gasfitter Master Journeyman 'Sicfnaeure of Licensed Plumber r Gasfitter Liccense Number rem WALITIMME (Print or Type) Check one: Certificate Installing Company Name WaJ/ �vu 13i/`r i -tri Q Corp. Address P.d, �/ o - Partner. Firm/Co. Business Telephone: 6/7 -0 qy-3 30_ / Name of Licensed Plumber or Gas Fitter GSc J, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [�!] Other type of indemnity Q Bond Ej Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent 0 I heteby 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 undo; Permit iuLrd fo: this application will be In compliance with ad pertinent provisions of tho Massachusetts State Cas Code and Chapter 142 of the General Laws. By Title City/Town: APPROVED (OFFICE use ONLY) TYPE LICENSE: Plumber Gasfitter Master Journeyman 'Sicfnaeure of Licensed Plumber r Gasfitter Liccense Number 40 Date..................... NORTPI TOWN OF NORTH ANDOVER OF t 1 M1' F A PERMIT FOR GAS INSTALLATION i ro i V SACH S "I This certifies that ....'............ V, ................. . has permission for gas installation ....................... in the buildings of .../:..........f ...:...................... . at ............. ` .................... , North Andover, Mass. r Fee......... Lic. No........... .......................... GAS INSPECTOR WHITE: Applicant CANARY: Building Ddpt. PINK: Treasurer GOLD: File Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that d1w t1c....... , 7% v has permission for gas installation�C � ....tZk .. in the buildings of . !�.'.�1!: ll'. �.�% ..: .............. . at .�� � n! 4" y.-�� ......... , North Andover, Mass. No.lJ,r�.. .......................... GASINSPECTOR ii heck # f.C, 5 �v. IASSACHUSETTS UNIFORM APPLICA (Print or Type) NO RTF{ A tjoo(111:.�2,, Mass. Da�( Building New ❑ Renovation ❑ r N FOR PERMIT TO DO GASFITTIN -4— acTog�IL Zg Permit ST - Owner's Name Klc`1142-21 Type of Occupancy e&%,,4P-,4 7l- Plans Submitted: Yes ❑ No Installing Company Name WITS. Rack {'LpyKaiV!N4 R*vVI b Check one: Certificate # Address PD 1;% 728 Corporation APO No. �gyypa/ p_ t V�jA . 6 !i6- ❑ Partnership Business Telephone °r?B • 275-r 4-2.99 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter __2DISE& INSURANCE COVERAGE: I have a current liability insurance Policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes y No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity f7 Bond F-1OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage jqguired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent --------- -----.- Owner ❑ Agent ❑ r top ouy cnrury roar as of ine oeiaiis ana information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent. provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title �( Plumber I I Gasfitter Gty/Town,l Journeyman Master f 1 i APPROVED (OFFICE USE ONLY) { Signature of Licensed Plumber or Gas Fitter License Number 6527 rn (n U) U W vi cr Z a cc W W Q Z S O ~ W Q m t7 �, W ►- w = Z O� o � O O Z > I— w cn W C7 W IQQ- fn Z cn W Z P Q Z = ar W cn Q W CW7 < W > F_ U- W F_ W _ W Q W > X W j H Z Q 2 rn Q W O 8 F' W it -J � W F." cc = O 0= u. 3 O 0 a: > o V a. W O SUB-BSMT. BASEMENT I ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR7t7t Installing Company Name WITS. Rack {'LpyKaiV!N4 R*vVI b Check one: Certificate # Address PD 1;% 728 Corporation APO No. �gyypa/ p_ t V�jA . 6 !i6- ❑ Partnership Business Telephone °r?B • 275-r 4-2.99 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter __2DISE& INSURANCE COVERAGE: I have a current liability insurance Policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes y No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy. Other type of indemnity f7 Bond F-1OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage jqguired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent --------- -----.- Owner ❑ Agent ❑ r top ouy cnrury roar as of ine oeiaiis ana information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all pertinent. provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title �( Plumber I I Gasfitter Gty/Town,l Journeyman Master f 1 i APPROVED (OFFICE USE ONLY) { Signature of Licensed Plumber or Gas Fitter License Number 6527 n N n m N V o> � C,. O� O low a 3 S _ / r ►-1 i' L, ul o°Y� 2 na mm �e w k i N m aa._ a a ® - m m rti r— m m co co I MTN Iq 4 Y� U G� \-t1 0 .J o Ln C7- rq t- m Q 03 2 W 139V130VNC)Vd eo-s (oo/co) goo AINO 'S'fl NIHlIM S1N3WdIHS UOQ a m 0 1NIad 80 3dhl 3SV3-Id 12 v®® 0 CD Mg CD H y rN Q o MEN C7 C7 w �CD CD T � 92 now 4A. CD n � C � O � co CD O caw `= CD CD N N ITI a ig M cm. o c o g, 9. � C; co w c L=J ~ Y b e0q. e , CD m CD Sr' 8 �3 G= 02 Anon w w -d -i ` w I w - U, Ln 0 0 Ir T, L-+ t-' M N � e � � m PLEASE TYPE OR PRINT FOR SHIPMENTS WITHIN U.S. ONLY C—Dpsi p G e 'd„ H cD PACKAGELABEL. 7 O co PC b $ by m � in ' F� r LCD 7r '- a 5 w ' u� R cr C a ts tr .ten li( a C7 G .a 8 �3 G= 02 Anon w w -d -i ` w I w - U, Ln Cl 0 Ir T, L-+ t-' ElR a m - O 9 m ❑ ❑CD 0 m c] p < O 7J a w m <a w C m CD ❑a d 'O d o� o O ^;Q m mO Nm M N w � r =rn x o013 I� I i I I I I I I I r