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Home My WebLink AboutMiscellaneous - Bldg 30�\ �� C� 4 0 '1 h1 0 Date ...... r.?�...^...?�.... � t f 40RTN , _te``°:•_�"�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that /L.� .............................................. P.......................................... has permission to perform 77t f " � i .............................................................................. wiring in the building of .. 6;�e� / Z at ......... ...��...��lcdo....... ?�.— ................ ..... .North Andover, Mass. 00 Fee..�25.':0.`. Lic.No...�..�1..................... ELECTRICAL INSrPECT Check # 8455 F1 PROolnooporated d Lee C. DeVi.to president 2922 T; ed Ig1.2"10.5200 . tedcom @ fiteproInCorpota.I' ldevito Www firepro. C,,Torated.com Experts .. _ .tants . Eng�peerS. Consu LING EXPER IENCE T r ECWOLOGy & SCONCE I l Code Consulting FA System D A�e nkler Syst., Desi sign Egress Syste f Litig honatiVS Design APProaches Ma ket e s Analysis / Witn PPort Research Marketing SnPPort Technicali Writing rw, Commonwealth of Massachusetts Department of'Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only [Permit No. S S' Occupancy and Fee Checked [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12 00 WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: —10/31/08 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 1600 O§gdod Street, North Andover, MA 01845 Owner or Tenant FIREPRO Incorporated Telephone No. 978-749-2750 Owner's Address 100 Burtt Road, Andover, MA 01810-5920 Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) PurposeofBuildmg Office Remodel Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Utility Authorization No. Overhead ❑ Overhead ❑ Comnletion Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters No. of Recessed Luminaires ------ - ---- No. of Ceil: Susp. (Paddle) Fans •---y — wulve uYtheinspecrorol wires. 0.0 Total - - - - - Transformers KVA No, of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above EJ ❑ o. o mergency ig g d. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIDE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Fnitiatin Devices No. of Ranges No. of Air Cond. TotaTons l No. of Alerting Devices No. of Waste Disposers eat Pump I Number _ .............................._.._.._. Tons IKW No. of self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Municipa ❑ l ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of WaterNo, of No of Heaters KW . Signs Ballasts DatN W fo. . Devices or E uivalent 25 No. Hydromassage Bathtubs No. of Motors Total Hp Telecommunications Wiring: No. of Devices or Equivalent 25 OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $1, 500 (When required by municipal policy.) Work to Start: 11/3/08 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including ""completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information o this applica 'o is true and complete FIRM NAME: FIREPRO Incorporated LIC. NO.: Licensee: Signature LIC. NO.: (Ifapplicable, enter "exempt" in the license number line) P.E. 87968 Bus. Tel. No.: 978-749-2750 Address: 100 Burtt Road Andover MA 01810-5920 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety"S" License: Lie. No. OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $125.00 t, F1 3 • R ter.141, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r� www.mars.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): FIREPRO Incorporated Address: 100 Burtt Road City/State/Zip: Andover, MA 01810-5920 Phone #:. 978-749-2750 Are you an employer? Check the appropriate box: Type of project (required): LEI I am a emplover with 8 4. ❑ I am a general contractor and I 6. Q Now construction employees (full and/or part-time).* 2. ❑ 1 am asole proprietor or partner- have hired the sub -contractors listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. Q Demolition working for mein any capacity. [No workers' comp. insurance workers' comp. insurance. 5.,[3 We are a corporation and its y, Q Building addition required.] officers have exercised their 10. ❑ Electrical repairs or additions 3. Q I am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself, [No -workers' comp. c. 1.52, § 1(4), and we have no 12.Q Roof repairs insurance required.] t employees. [No workers' 13'Q Other comp. insurance required.] -P-ny appr1cam that checks boX tt 1 must also Mi out the section below showing their workers' compensation policy information, t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-conttactots and their workers' comp. policy infnrmadon. 1 am.an. employer that is.providing:workers' compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name: CNA Insurance Policy # or Self ins. Lic. #: Policy 1'x`2067275129 Expiration Date: 5/1/2009 Job Site Address: 1600 Osgood Street City/State/Zip: North Andover, MA 01845 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here/bgiyp certify FIREPRb Inco Phone #: 978-749-2750 that the information provided above is true and correct Presi ficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # 0/31/08 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 -contractors) name(s), address(es).and phone number(s) along with their certificates) 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' r 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 permitAicense 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 firture 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 Basion, MA 02111 Tel. # 6I7-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7744 Revised 5-26-t15 www_mass.gov/dia CNA 10/31/2008 11;08 AM PAGE 2/003 Fax Server �`IinnHi• 11271 I3T_7=1DI3Te7 ACORDTM CERTIFICATE OF LIABILITY INSURANCE ia31/08D/YYYY`) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CNA Service Center PO Box 16275 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, PA 19612 POLICY NUMBER 877 724-2669 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: American Casualty Company Firepro Inc. INSURER B: Transportation Insurance Company 100 Burtt Rd Andover, MA 01810 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR N R TYPE OF INSURANCE POLICY NUMBER DATEPOLICY EFFECTIVE POLICY EXPIRATION DATE fMM1DDNYI LIMITS A GENERAL LIABILITY 1036753798 08/16/08 08/16/09 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 ^ CLAIMS MADE U OCCUR MED EXP me person)$10,000 PERSONAL &ADV INJURY s2,000,000 GENERAL AGGREGATE s4,000,10010 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4 OOO OOO POLICY JECT PRO X LOC A AUTOMOBILE LIABILITY ANY AUTO 1036753798 08/16/08 08/16/09 COMBINED SINGLE LIMIT $1,000,000 (Ea accldertf) BODILY INJURY $ (Par Perms) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) X X HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ B EXCESSIIIMBRELLA LIABILITY 2086709949 08/16/08 08/16/09 EACH OCCURRENCE $3 000 000 X OCCUR FICLAIMS MADE AGGREGATE $3,000,000 $ DEDUCTIBLE $ X RETENTION $10000 B WORKERS COMPENSATION AND 2067275129 05/01/08 05/01/09 )( WCSTATT OTH- EMPLOYER S' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTWE E.L. EACH ACCIDENT $100 OOO E.L. DISEASE- EA EMPLOYEE $10O OOO OFFICER/MEMBER EXCLUDED? If yes, desvlbeunder SPE AL PROWSION$ belaw E.L. DISEASE- POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Proof of Insurance Town of North Andover Building Dept. 1600 Osgood Street North Andover, MA 01845 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITSAGENTS OR AUTHQRIZED REPRL7NT�4I1 AGURD Z5 (Zuul/u6) 1 of 2 #235394 PHRR Q ACORD CORPORATION 1988 4 M 0 CNA10/31/2008 11:08 AM PAGE 3/003 Fax Server q + R IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACUKV zs-s (zovvos) 2 of 2 #235394 "EP October 31, 2008 Mr. Peter Murphy Electrical Inspector Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 Re: FIREPRO Incorporated 1600 Osgood Street Dear Mr. Murphy: It was a pleasure meeting you this morning. Per our conversation regarding pulling data and communication lines, please find enclosed the Application for Permit to Perform Electrical Work and the application fee for our new office space at 1600 Osgood Street. We have included a draft of the office layout which will be finalized by Monday morning. Please call if you have questions regarding the enclosed permit application or drawing. Thank you. It Regards, FIREPR aocorpor w Lee C. DeVito President Enclosures FII�EP9KO,, Incorporated One Hundred Burtt Road, Andover, MA 01810-5920 Phone: 781.270.5200 Fax: 781.229.2922 www.fireproincorporated.com Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING , � k � , ee -- � 7 — Thiscertifies that ............. A .............................................................................. has permission to perform -r-,�' /) ..................................................................... ......... Al - — wiring in the building of ....... .1 2;" �' ............................. i ......................... at .16-61(2?eftb ..... 5,7 .. ............................. North Andover, Mass. ....... Fee . ................... Lic. N .1. 4 ......... ... I ELECTRICAL INSPECTOR ....... Check # 8460 'ti Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �Y�Q Occupancy and Fee Checked Lev. 1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC), 527 CMR 12.00 (PLEASE PRINT INWK OR TYPE ALL INFORMATION) Date: 2 0 City or Town of.- NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 1600 QS c OC) SJ . Owner or Tenant )W-0 0$' W St 0Z Owner's Address r 6CO S ti ouch 31 `,Lc dt vL30, &4 � re pra Telephone No. Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building O�� e e Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity ) - .12SWµ8 " i'wI1,2Z 12.01.2,06'JOE."r FCC Ae(� (y 2 Ctci . 22S11 hLo. ptj Location and Nature of Proposed Electrical Work: bait w 2-01 2nd PLodn No21� SiAe (i, -,t coon ON2i5�i a�- Y) o CZ -Pout to 'INCIUdea 9f ce TyrLM,i-v1p �nev-Te[ccoN 6 o�en.S . No. Hydromassage Bathtubs table may be waived by the No. of KVA KVA ❑ 1140. or r:mergency—LM—hiNi— Batter Units _ FSE ALARMS 1\To. 0f Z.ones o. of Alerting Devices tion/Alerting Devices ❑Municipal rnnnarlinn ❑ Omer No. of Devices or :a Wiring: No. of Devices or o. of Motors Total HP (Telecommunications No. of Devices or Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. VZ -00-0 (When required by municipal policy.) Work to Start: I2 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO 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 cov rage is in force, and has exhibited proof of same to the permit issuing office.CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: b c ILL EL e C' -,t C Co. C . LIC. NO.: 1 $03 4 Licensee: W t, y K C W• S� i f P 5 Signature _�wy� LIC. NO.: b SU 3 (� (If applicable enter -exempt " in the license n tuber line.� Address: 13 Q r'A. 14V. S� vMl lV (-1 03U7� Bus. Tel. No.1403-76S-972) Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Completion 01 11 No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Luminaire Outlets No. of Hot Tubs No. of Luminaires ing Pool Above ❑ In - d.91711 No. of Receptacle Outlets il Burners #,No. No. of Switches as Burners No. of Ranges No. of Air Cond. Total Tons No. of Waste Disposers Heat PumpNumber Tons I Totals:___.._.._ ..._. _._.._ ... No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Appliances KW No. of Water, Heaters No. of No. of Signs Ballasts . No. Hydromassage Bathtubs table may be waived by the No. of KVA KVA ❑ 1140. or r:mergency—LM—hiNi— Batter Units _ FSE ALARMS 1\To. 0f Z.ones o. of Alerting Devices tion/Alerting Devices ❑Municipal rnnnarlinn ❑ Omer No. of Devices or :a Wiring: No. of Devices or o. of Motors Total HP (Telecommunications No. of Devices or Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. VZ -00-0 (When required by municipal policy.) Work to Start: I2 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO 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 cov rage is in force, and has exhibited proof of same to the permit issuing office.CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: b c ILL EL e C' -,t C Co. C . LIC. NO.: 1 $03 4 Licensee: W t, y K C W• S� i f P 5 Signature _�wy� LIC. NO.: b SU 3 (� (If applicable enter -exempt " in the license n tuber line.� Address: 13 Q r'A. 14V. S� vMl lV (-1 03U7� Bus. Tel. No.1403-76S-972) Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ n R Permit NO: Jd, Date Issued: 10, BUILDING PERMIT TOWN OF NQRTH ANDOVER APPLICATIO ,61 WWAN EXAMINATION # / Date Received gAr.o r.Pa _45 I / IMPORTANT: Applicant must complete all items on this paize I MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration z--- No. of units: Commercial— Repair, Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer 0 OWNER: Name: Address: CONTRACTOR DESCRIPTIPN OF Identification BE PREFORMED: or Print Address:l�a Supervisor's Construction License: , mfr Exp. Date: Home Improvement License; Exp. Date- ARCHITECT/ENG I NEER ate: ARCHITECT/ENGINEER ! Phone:�� Z. n Address: i W� _ d, V' e�-lA,4 e-,— Req. No FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ f/,S `� A--- FEE: $ Check No.: 176/ 6 Receipt No.: x/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund re of Agent/Own! ..`�=--- Signature of contractor_ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art - Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 301 (10/30/08) Date: December 30 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1600 Osgood Street, Building 20 MAY BE OCCUPIED AS: Tenant Fit -up (Firepro, Inc.) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Qm Properties 1600 Osgood Street ,North Andover, Massachusetts 01845 l Building Inspector U) m m x CA F, m M C CO) C7 CD Z CO) 0 O ri• r d= CO) .o o C-) O c CD CD O CT % d CD CCD O CCD C CD y CD CD d O_ y O to CD v y O 'CD CD Z 71 O CCD O CCD O Q v z cn C c =rO so cn �' fD O —•vioQ So o H _S t/) -`� ►n 0- 0CD O ®n cn ►n C, H C! do cv, T Z _lo ' CO) --4 o a o CD d=0 m = y OO .-I0 M. ,m 05,00 0 -� o f o a > > c m � = o, o O y. 0,., OZ =N a C a.w •.:•t CL :�...< �C O= ? O CS O� :.. c CL Hto o' N d d C' CCOD ,. = m N O CA m � m d CA 3 CD as: 0 0 wo CS CD CD WimIm: co a m to d-o 'p co � o gyCD: �q cn cn u7rn ., � a 0 cn �' fD � 0 5 -`� ►n 0- 0CD cn ►n d o cv, ( j n �. r o O z 0 0 c '2015 8:17AM Wdfp� t•rom: 1600 Osgood St. LLC 1600 Osgood St. N, Andover, MA ja c 5 � P. v I pleTo:1978&$$95y9 t'.1�1 �(I1C5 �Pellyj 41K 1+6rm NOZ04A I Form used with OZ04 FIRE PROTECTION IMPAIRMENT PERMIT lasue 01 FOR NAFD LIEUTENANT ON `DUTY REQUEST FOR CONTROLLED SHUTDOWN The PERSON requesting the impairment shall: a) Complete the applicable italicized pari$ of this form. b) Sign the form. c) Give the form to the knpairmsnt Coordinator 24 hours In advance, d) Follow any special requirements. 1, What will be impaired? (sprinkler zone, equipmeni, elc) ZONE - 02 Construction Work 2. What will the Impairment affect? (floors, cots, areas, e(c) 20-01 Ko - Ela 1-6 20.02 Ko - Leto 1.5 20.03 Ko -- Eta 1-6 Check IP _Audio visual system (life afafm) impaired _Drawing allached (ta)r a drawing of the building!area affected, if necessary) 3. Whan will the impairment begin? Starts approx. at 7:30 AM. 9111115 4. How long will the Impeirmeni lest? Lasts until approx.11;30 am 9111115 5. Are any special precautions being taken? (Give relevant details-) Tec 87#4f5.7262 Data., 4dli3 Signaturo and Tel p of person planning rMpOimkrrtl Ted Dowgiert plintvd memo ofpoaaon planning imp?i—*a Dowgiert Construction Company ropromatod 7116/05 Tho IMPAIRMENT COORDINATOR • Completes this part. • Faxes it to the NAFD Lieutenant on duty at 978-688-9594 one day before the impairment. a Informs NAFD at 978.680-9590. D, E, or F per Col.1 in ( 04 lable.) LASS THAN 4 HOURS Precautions taken: Comments: 4 HOURS OR MORE Precaution taken (check one): _A fire watch, or a special arrangement with emergency responders A temporary water supply _Elimination of potential ignition ftouress, and limitation of available fust _Evacuation of affected areas Other precaution(s) taken, y�� 4 Deto: re of imp ent COordinntor, or detognte.) NAFD + Completes this part . Faxes it to 978-6814520 + Informs the Impar ant Coordinator at 978- 4234 2 I have approved the Im irfnenl. _-..,. ..Date I have rejected the The IMPAIRMENT COORDINATOR • C+pletes this part Faxes it to the NAFD Lieutenant on duty, 978688-9594, after the Impairment. P vordfv tta later -&%d Coordinator, or delegate) Date/'J:� V . ��/. , TOWN OF NORTH ANDOVER MR MW 11 �• ' PERMIT FOR PLUMBING i f�ifiG ; i This certifies that . ......... �! .`" . .. . '........ . has permission to perform ....................... plumbing in the buildings of ,�, D11..Dl�oo 02-z at t'"�h ?.0..-XA? 41.............. , North Andover, Mass. Fee P'r-4... Lic. No...�,3!� mss ........................... . v�a�� PLUMBING INSPECTOR Check # G,! 7927 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location f17- Owners Name �O Date Permit # T e of Occu ancAmount New Renovation Replacement ' Plans Submitted Yes ElNo ii TP7'TT7T ren krrim orrype) 1/ Installing Company Name /C/�l`!i t /' Check one: Certificate (.� � Corp. Address FrJ ' U 7 9 ❑ Partner. usiness TeIephone FimVCo. Name of Licensed Plumber: kr;' V Insurance Coverage: Indicate thetype of insurance coverage by heckmg the appropriate box: Liability insurance policy P, Other type of indemnity ❑ Bond Insurance Waiver I the unders.•i.• m three insurance ed, have been made aware that the licensee of this application does not have any one of the above Signature Owner ❑ ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in best of my knowledge and that all plumbing work and ins;ations performed under P compliance withal] pertinent provisions of the - / [B- 3 - (APPROVED (OFFICE USE ONLY Type of Plumbing License t. j rcense 114UMDer Master rove application are true and accurate to the mit Issued for this application will be in Chapter 142 of the General Laws. Journeyman Rs rA rA w W w A por. ca � o _ w V, •a cn 1-4 c.4 w z a w° w°' U ca w w R, a�G �n w x o a W �° cn u. a p U w a C7 C4 � w z w a G co o V) v o cn O z -ti L- IE N Z N 0 N C ID O C: c m `o cm S C N CD t r.+ 0 Z O 0 F. a 0 u 0 Z 0 U T MI. U 0 CD O co 0 o Z co CL O h � C 40 CM � c C CA p 'C O y O O �E m m 0 CD O � O e_wv `o a CL cna cc ccc v J= C Z � V Na O C •C C c CLH U) U) W W 19 W 0 TOWN OF NORTH ANDOVER Construction Control Affidavit Project Number: #0808103 Project Title: Firepro, Inc., Tenant Fit -Up Project Location: 1600 Osgood St, Building 20, 2nd Floor Name of Building: Building 20 Nature of Project: Tenant Fit -Up Plan for Firepro, Inc. In accordance with Section 116.0 Registered Architectural and Professional Engineering Services -Construction Control of the Massachusetts State Building Code, I, Gregory P. Smith Registration No. 8688 being a Registered Professional Engineer/Architect, HEREBY CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural )0000 Fire Protection Electrical Structural Mechanical Other (specify) FOR THE ABOVE-NAMED PROJECT AND THAT SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE 780 CMR MASSACHUSETTS STATE BUILDING CODE. ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the state of construction to become, generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. UNDER SECTION 116.4, I SHALL PERIODICALLY SUBMIT A PROGRESS REPORT, TOGETHER WITH PERTINENT COMMENTS, TO THE ANDOVER BUILDING INSPECTOR UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE NOTARY PUBLIC LINDA VANDEV00RDE Notary Public - New Hattgllhr nhv ^nmmission Expires March 10, 2009 )8 10/28/2008 13:35 FAX 19786833147 H.P.ROBERTS INSURANCE 19 001 -RD. CERTIFICATE OF LIABILITY INSURANCE vV�car.v DAT 10/28/08 PRODUCER M.P. Roberts Insurance Agency 1060 Osgood Street North Andover, t91J, 01645 THIS CERTIFICATE IS ISSUED AS A MATTER OF, INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HDLOM THS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVMGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC 0 RvsuRED DOWGIERT CONSTRUCTION CO., INC 616 ESSEX STREET LAWRENCE, tom! 01841 gVSURERA: P,rovidonce Mutual mquRER t3: Gusrd Insurance R45URPRC: UISURER D: INSUKA E: THE POLICIES OF INSURANCE LISTED BELOW HAVE MEN 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, E)OCL.USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY RUMBER POLICY GTR1B POUCH E]IPIRA ONTYPPOFINMIRANCE LIMITS GENERAL LIABILITYCi►0'00"0 X COMMERCIALGENOMLIADIUTY CLAMSMADE � OCCUR NCE S 1.0 0 000 Duuw ORm w S 100,000 MfD EXP aw Fars i 000 PERSONALSAOVNJURY $ 1,000,000 A CPP0064437 10/26/08 10/26/09 GEWR►LAGGRE130S S 2,000,_000 GEMLAGOREGATELMITAPPUESFEER FRWUCTS-COMPJDPAGO S 2,000,000 POLICY F-ILDC AUTDMOSILELIABILITY COAISINEDSNQAUMIT S (BlAaddwK) ANY AUTO AU-OVWEDAUTOS SCHEDUWD AUTOS BODILYNJURY S IRF P—) HSREDAUTOS NON4"ED AUTOS BODILYNJURY S (Rx asidn! ) PRCPERTYDIIMAGE $ GARAGE LIABILITY AUTOOKY-EAACCOWT S OTHERTHAN EAACC S AUTOON.Y: AGO S ANYAUTO E=ESSNMBRELLALIASILITY EACHOCCURiENCE_.-_ S AGGR63ATE $ OCCUR CLAIMS MADE S - ........ $ r. DEDUCTIBLE S RETENTION S vaC SlA 0TH. WORKERS COMPENSIM00 AND ELEACHACODENT e 11000,000 H BIIPLOYERS•LIABRJTY ANYPROPRIETORIPARTNERIEXECUTIYf OFFICGRIMEM ER EXCLUDED? DOWC911544 10/26/06 10/26/09 J:L OISSA$i.EAENPLDfEE S 1 000 000 ELDISEASE-POUCYLMIT S :L'000,000 war 0am brAmw OTNHt DESCRIPTION OF OPERATIONS 1 L CKMIMNS / VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS F-503-458-1090 SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EWMTM TOWN OF NORTH ANDOVER DATE THEREOF, THE ISSUING INSURER WILL ENOF.AVOR TO MAIL 10 DAYS WRITTEN 1600 OSGOOD STREET NOTR:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 60 614A WORTH ANODVER, MA 01845 ►Mp= NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER• ITS AGENTS OR REPRESENYAYNES. AUTHORIZED REPRESENTAMVE A en ./�nnn AmmnDA'nf%U 11620 ACORD 25 (2001108) ..._-- — -- - - - - --- r NThe Commonwealth of Massachusetts ' Department of Industrial Accidents have hired the sub -contractors Office of Investigations .iMill, 600 Washington Street These sub -contractors have Boston, MA 02111 r ;~ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: ./2 C3 Phone #: 17 Are you an employer? Check the appropriate box: 1. [9�am a employer with . l c) 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised. their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7.]'Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -Any applicant that checks box # I must also till out the section below showing their workers' compensation policy information. Homeowners who submit ['his of iidavii uhdicating they are dui;ig all work and iihen hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information 2 Insurance Company Name: Policy # or Self -ins. Lic. /` !2_41 �� ' f Expiration Date: - Job Site Address: /� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the -pains and penalties of perjury that the information provided above is true and correct. Phone #: `i �1 - � �_C) :2�2 I—el) �. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # G Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the. insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Location No. ` Date f TOWN OF NORTH ANDOVER ,. • p 9 Certificate of Occupancy $ /00 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F Check # (s� 21643 .//'1ui1g Inspector