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Permits for Wiring - Building Permit - 16 BERRY STREET 2/10/2026
i Date......I �.���.��. ............ l of NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING x: 88ACHUg� . vA� .............. This certifies that ..........................................�`..�..:. ......... ............:...�:.� t 6 I .has permission to perform e � .E j wiring in the,. uildnof, . e ............................. at ...... � ..... ..........,North Andover,Mass. /ba Fee...� .1........Lie.No.� 3?�.. .... ` � ................ �... LECI'RICAL INSPHCTOR Check# I Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9/ 4s 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 bellow. Location(Street&Number) &:;Q k� 4�1 T. AC-2E 3 1 1 Owner or Tenant t J( n-1 AteOC, i ,&,(, L.irG Telephone No. Owner's Address t t4' SiE 2%O tom_>2!) M A c�i Is this permit in conjunction with a building permit? Yes [ No ❑ (Check Appropriate Box) Purpose of Building APAf?,THa)T &M 0)k)!-r Utility Authorization No. Existing Service Amps , / Volts Overhead ❑ Undgrd ❑ No.of Meters ew Service r O Amps l;?0/9-69, Volts Overhead ❑ Undgrd Q No.of Meters ------------ Number of Feeders and Ampacity SC- A ( ) i7k�t Location and Nature of Proposed Electrical Work: ,JE U.0c-j Q 0CT76&) 'l S -4-�741 '1 01,-�f T- Completion of the following table inay 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 Above In- o.o Emergency Lighting No. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ 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 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I 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 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 E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:&)'.3 /S Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: E LIC.NO.: J 2. Licensee: Vt© j� , �� � -- Signature�, LIC.NO.: 2 (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.-(06 t'—)39•`78'�� Address: 9z) eg�& 1 iy Mt-£DiTIA i'1i-1 caZ51 Alt.Tel.No.: W b i-` QS.1.0 *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 11 vAow The Commonwealth of Massachusetts Department of IndustrialAccidents b 1 Congress Street,Suite 100 Boston,MA 02114 2017 r wlplp.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILE,D WITH THE PERWffffING AUTHORITY. Annlicant Information Please Print I�et7ibly Name(Business/Organization/Individual): SE_:4- Address:_s'� i PEA, ,i City/State/Zip: &v- L Phone##:C(2-�� 9— Are you an employer?Check the appropriate box: Type of project(required): 1.)R Iama employer with_employees(full and/or part-time).* .7. RNew construction 2.o I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity,[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition i 10[(Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurancex 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other { 152,§1(4),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, If the sub-contractors have employees,they must provide their workers'comp.policy number. f lam an eniployer'that is providing iporkers'compensation insurance for my employees. Below is the policy and job site inforlJration.Insurance Company Name.—Aim m l� i��t�— I Policy#or Self-ins.Lic.#: t� -�tC1��� � EJN Expiration Date.. cc Mt Job Site Address: --I (A �-¢, ��t`"� S City/State/Zip: Awjdl, C)` /�' j Attach a copy of the workers'co pensation policy eclaration page(sholving the policy number and expiration date), j Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 i 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 i day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains all penalties of perjury that the it formation provided above istrue and correct. signature: Date: Phone#: t� Official use only. Do not sprite 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �- SE&DI-1 OP ID:JO LIABILITY 'NSURANCEDATE(MMIDD/YYYY) CERTIFICATE OF 09/21/2016 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS _-CERTIFICATE-DOES_NOT_AFFIRMATIVELY_OR_NEGATIVEL_Y__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(ies)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 CONTACT John DUSsault Foster Sullivan Insurance NAME: 163 Main St. AICONr o Ell:978-686-2266 FA/X Ne:978-686-6410 North Andover,MA 01845 E-MAIL Foster Sullivan Insurance LLC ADDRESS:certificates@fostersuII!vangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A MAIN ST AMERICA ASSURANCE CO 29939 INSURED S.E.&D.Inc.,Electrical INSURER B:TRAVELERS INSURANCE CO 19046 David Street PO Box 114 INSURERC:A.I,M MUTUAL INS CO 33768 Meredith, NH 03253 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURER E:ESSEX INSURANCE COMPANY 139020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 COVERAGES CERTIFICATE NUMBER: 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. 1�TR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY MM/DDP(YW LIMITS GENERAL LIABILITY EACH OCCURRENCE § 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2015 08/29/2016 DAMAGE SETO RENTED T ea occurrence). $__ _300,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 A X BLKTAl WRITTEN CONTRACT PERSONAL BADVINJURY $ 1,000,000 A X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PRO_ RO LOC S ----AUTOMOBIL-E-LIABILITY— —--- --- — — C9�B NED SINGLE LIMIT____ — (Ea a..._.dent) -- $ 1,000,000—--- B ANY AUTO BAOF132412 07/29/2015 07/29/2016 BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED — -"'- AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LIAR X FICCUR EACH OCCURRENCE $ 5,000,000 E EXCESS LIAB CLAIMS-MADE XOBW6340714 08129/2015 08/29/2016 AGGREGATE $ DED X RETENTION S 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETORIPARTNER/EXECUTIVE Y/N VWC-100-6017018-2015A MA 01122/2016 01/22/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A D (Mandatory in NH) WC5-31S-389186-033 NH 08/29/2015 08/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 TE 1834827 03/20/2015 03/20/2016 CRIME 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All-rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD BOA `QF E% C I AN L�SUES.THE FALLOWING L10ENS'E AS A REG I`ST.ERED MASTER E'LECTRLC I AN pAV:1D`STREET ELECTRIC INC =u. DAVID H STREET'< W PG, HpX; l14 0114 MEREDITH ;NH p3253 g3623 54 pZ� 1 16 16 Berry Street- Building Four 48 Units Bldg. Four Building )ec rN l Plumbing/Gas Notes Uni # 1 Rough IZZI Final 2 Rough Final 3 Rough Final 4 Rough Final 5 Rough Final 6 Rough Final 7 Rough Final 8 Rough Final 9 Rough Final 10 Rough Final 11 Rough Final 12 Rough Final 13 Rough Final 14 Rough Final 15 Rough Final Bldg. Four Building Electrical Plumbing/Gas Notes Unit# 16 Rough Final 17 Rough Final 18 Rough Final 19 Rough Final 20 Rough Final 21 Rough Final 22 Rough Final 23 Rough Final 24 Rough Final 25 Rough Final 26 Rough Final 27 Rough Final 28 Rough Final 29 Rough Final 30 Rough Final Bldg Four Building Electrical Plumbing/Gas Notes Unit# 31 Rough Final 32 Rough Final 33 Rough Final 34 Rough Final 35 Rough Final 36 Rough Final 37 Rough Final 38 Rough Final 39 Rough Final 40 Rough Final 41 Rough Final 42 Rough Final 43 Rough Final 44 Rough Final 45 Rough Final Bldg. Four Building Electrical Plumbing/Gas Unit# 46 Rough Final 47 Rough Final 48 Rough Final Date ?,.:�.).!.�.�............. fF aoRrH TOWN OF NORTH ANDOVER * y PERMIT FOR WIRING ,�BgCHUS�t I i K I This certifies that has permission to perform �t� wiring in the building° � .......................................... at o ,North An Fee 1 yid ass. � s � •ob.......Lic.No. lover,M Check# ELECTRICAL INSPECTOR..... ........... ��� Commonwealth of Massachusetts O-7fficial� �1-�'iUse Only Department of Fire Services /i Permit No. � Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: %h?,3 1a l City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1(p AE�2.g Owner or Tenant 1�1c`�R1�-I AKIj,"ZP lJoi ()j tC -, LLG Telephone No. Owner's Address i-!() pQ�S,n�iTig(_ t,iae Sm- P-w w )Pw Ha (,)I�I Is this permit in conjunction with a building permit? Yes [N No ❑ (Check Appropriate Box) Purpose of Building APAP-Tt-JUT ( ►LP)k)(7 It Z Utility Authorization No. Existing Service Amps , / Volts Overhead ❑ Undgrd ❑ No.of Meters ew Service , C Amps /GO/POPVolts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity (p 2 Gc i se).q. 16. g A 3 Location and Nature of Proposed Electrical Work: N t y, �Pt` ta'. 10 q t_)A.) I-r AET HE LL-: 130l L-N :i as I T1;1 64&4617, i ce)D62 - Com letion o the followin 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 In- o.o mergency Lighting rnd. rnd. 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 No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: I I 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 No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No,of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: -)"3 Ide)i • Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OVERAGE: 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 pen-nit issuing office. CHECK ONE: INSURANCE [K BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Q LIC.NO.: `] J k Licensee: 01 o j� , � --� Signature ,J P LIC.NO.: S N M 2 (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:(Cd S-2]9•`7fi`7�' Address: & Wv& IN Mf-I=,l�m K�H cbm,l Alt.Tel.No.: tQb3•`7(ps-40 *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: 16043-1 The C'omnionwealtla of Massachusetts Department of Industrial Accidents b 1 Congress Street,Suite 100 Boston,MA 02114--2017 ww►p.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Elech'iciansf.Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Letribly NaMe(Business/Organization/Individual)! C�— t) 1 1,,s c-- Address:_ ,-� City/State/Zip: Phone Are you an employer?Check,the appropriate box: Type of project(required): 1.10I am a employer with employees(full and/or part-time).* 7. RNew construction In I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insuranconquired.]t i 10 n Building addition 4Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole ME]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lain an employer iliat isproviding iporlrers'eonrperrsatiorr irrsurarice for my employees. Below is thepolicy andjob site i information. Insurance Company Name..—Aim Policy#or Self-ins.Lie.M VW WJ 601?0 g—�VAP ' Expiration Date: Job Site Address: t?. 'tr"7� ��`� S CitylState/Zip: Attach a copy of the worlcers'co pensation policy eclaration page(sho)ving the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 i and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 f do hereby certify under the pains art penalties ofpei jury that the information provided above is trite and correct. Signature: Date: Phone#: Official irse 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SE&DI-1 OP ID:JO CERTIFICATE OF LIABILITY INSURANCE 1 09/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS -CERTIFICATE_DOES_NOT-AFFIRMATIVELY_OR.NEGATIVEL —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(ies)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 CONTACT Foster Sullivan Insurance NAME: John DUSSaUIt 163 Main St. AH�No Elt:978-686-2266 Aro No;978-686-6410 North Andover,MA 01846 E-MAIL tifit ftlli Foster Sullivan Insurance LLC cer caes osersuvanrou ADDRESS: g p•com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:MAIN ST AMERICA ASSURANCE CO 29939 INSURED S.E.&D.Inc.,Electrical INSURER B:TRAVELERS INSURANCE CO 19046 David Street PO Box 114 INSURER C:A.I.M MUTUAL INS CO 33768 Meredith,NH 03263 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURERE:ESSEX INSURANCE COMPANY 39020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE DDL BR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2016 08/29/2016 DAMAG O T-D 300,000 -PREMISES(Ea occurrence). $ CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 10,00 A X BLKTAl WRITTEN CONTRACT PERSONAL&ADVINJURY $ 1,000,000 A X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PROM JE C LOC $ — -- AUTOMOBILE-L-IAB161TY ---- ----- -- ____---______ COM_BINED-SINGLE LIMIT __ Ea acaaerit $— 1_000_00 -- ...... B ANY AUTO BAOF132412 07/29/2015 07/29/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED Per AUTOS AUTOS ( )BODILY INJURY accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 E EXCESS LIAB CLAIMS-MADE XOBW6340714 08/29/2015 08/29/2016 AGGREGATE $ DED I X I RETENTIONS 10,000 Is WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS I I ER C ANYPROPRIETOR/PARTNER/EXECUTIVEY/N VWC-100-6017018-2015AMA 01/22/2016 01/22/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA D (Mandatory in NH) WC5-31S-389186-033 NH 08/29/2016 08/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belo I E.L.DISEASE-POLICY LIMIT $ 1,000,000 F CRIME 1834827 03/20/2015 03/20/2016 CRIME 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS, 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All,rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 9 HQARR C?F E°LECTR'I C 1 Ell TANS ISSUES THE FALLOWING LICENSE AS A REG{ST) REA MASTER ELECTRLC I AN ' DAV.I>}-STREET ELECTRIC INC H, IDAVID H STREET J. PO BDX 114 0114 ME.REDITH NH a3253 8 623. o /31 16 Berry Street- Building Two 64 Units Bldg. 2 Building Electrical Plumbing/Gas Notes Unit# 1 Rough Final 2 Rough Final Q 3 Rough Final d?4 Rough Final (j 5 Rough Final (� V 6 Rough Sj Final 2 7 Rough Final ?� Rough Final 9 RoughZ� Final Z 0 Rough S�j Final 11 Rough n Final 12 Rough Final ZU '13 Rough Final 14 Rough L3 Final 151 Rough Final Bldg. 2 Building Electrical Plumbing/Gas Notes Unit# / 7,16 Rough L Final 17 Rough Final 018 Rough Final ' 19 Rough z Final -Z 20 Rough Final a 21 Rough Final 22 Rough Final 23 Rough Final 24 Rough Final 25 Rough Final 26 Rough Final 27 Rough Final 28 Rough Final 29 Rough Final 30 Rough Final Bldg. 2 Building Electrical Plumbing/Gas Notes Unit# 31 Rough Final 32 Rough Final 33 Rough Final 34 Rough Final 35 Rough Final 36 Rough Final 37 Rough Final 38 Rough Final 39 Rough Final 40 Rough Final 41 Rough Final 42 Rough Final 43 Rough Final 44 Rough Final 45 Rough Final Bldg. 2 Building Electrical Plumbing/Gas' Unit# 46 Rough Final 47 Rough Final 48 Rough Final 49 Rough Final 50 Rough Final 51 Rough Final 52 Rough Final 53 Rough Final 54 Rough Final 55 Rough Final 56 Rough Final 57 Rough Final 58 Rough Final 59 Rough Final 60 Rough Final 61 Rough Final Bldg.Two Building Electrical Plumbing/Gas Notes Unit# 62 Rough Final 63 Rough Final 64 Rough Final Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that . ..................................................................................... ........................... --7 has permission to perform " 0-/- ................... .......................................... ............. wiring in the building of.......... ........ ........ .. ... .... ................................... �ra-- at ..........................................I.............. ..... ........No Andover,Mass. .............Lic.No. ........... ............... ...... . . .................. ............ ELECTRICAL INSPECTOR Check# CJ!")"7Pt1 /"Pt✓tA'ealth of Massac117 use tts � �ri�i�.�i,dDepartment cof l ,c:t>orly /Ia ww11a.11111 No re ServiceS ( tc(;tipancv ,and I co ('hcck"'d �� ;� 1;1,0Aiw ) Oi i I1tii— d'is'i._.A/i �) HON 1`1I:I ,i.VA FUR; _ tlr dti�• I�I<uil�) APPLICATION I ci r ,Rod PE , d PERMIT .r1 ( 0 PERFORM ' <�(Nil �ELECTRICAL FORK f'HIN I'l'� {N/"r" i)l� ITN"'At. tNt•� I i t,��f 7 )") WIN: 5N: E t A the hmps r for r�� Gf)rc lv�, thr, t�r�,l<<,uir�n �Id�. cud<I�.•� ni nc(I)l�,vl,���i�u,�i<+11)(l�� I�:i��rr dn�c... I(1 Uk ��l)"v1 it (it': N� V 1 diir a to per,9irrn, itd� �c„r.Uict�! �,co�l� dc"scidwd below ( acncr or fcuaok - - oc�rkron .,Ircck &( I'cl,�l rfrorrc No. Is klriw pe"Uh in cnnlunc°tion cviklr a brriltlintr Pcrmrt•. 1 es Nn ( T"k AppmpriMe Hoc) _. i orposo ol,k nilding, �' t q . ,,N• " 1 �.nt°..; / d.,tv lk".G ..Q. r _ t�tilitr 0utboriiation Nu. h•-�i>,kirr,.; �icr�rcr - _ \olps . 0wcrilea ( rrrr�rd r. , I\Ictcrs vctti'. r r�i4 r olt.� Ovcrheml �_ C rr,l :'rcl .� `der. u ctcrs Nuntbcr of, i cc•rlcrs anal ,1111pacOy 31ino and NArurc of I'ro xrscd Klectrical W j I n l�: - t `� K..s. c 1 i�: � � (•�� ; ASS,- � � r �,nr/,(�rrru�r a/,Ir< ;r"lu �rrr; nrL1,�ri,,rr (�� c un r•rl Gt lhr�int �,r R�ru/ I(�,No. ol`kcc c,wvd I.unrintrires No, ol•('cd. )osp. No• r,t t of rl Ir;rrrsttrrorcr's I�� ;'1 No, ol,I'll mill>lirc Oudcts No. ok•I lot I'ol)s (;encr,r[ors KVA ,-.r rrd. rm1, I,srklc rw t rrrie o. uk I.luoioaires ;�tnurrriIw Pool �bovc !n Ao ol`t^;urcr cnc� I r;Til'iu a l _.._.._ _. 1 tI r Vo. of I�ccc if;rcic Uoticts No ol'Od I�ur•uers (� t1�' `*1,�I(tit�; No. of"Zonc^, No• ok `scvi(cIIv,; Na. of C�;rs I'�urncr v �N o• crl•I)ctr_cfirin A6 No, ol'Air ( mol 1c�ti�lur I)I)o ices itcs °vu. ol� It,rn . No. ill,��rw I ot;rl `rlo. ol,1! ;rskc I)isposcrs neat I unr ) "sumbcr I one, 1� N, Hsu. of �cl( l nnt,�inw tl _. I'otad5. i tckr c tion/.Ut r til Ihvrt_cs No. of k)rsh" Isher•s i ))celkrt r Heathy I W I,ocal ttuniciprl - t f l C 7 c�tlrt r �� ( nnnccrrnrc - No. of 1)rvcrs IIr )lurrg Appliances I�\4 wccturt' ')' fours: No of'A)c vic cs or I (Iniv dent o. o M atc r s Iti1t No of• 'vo. ul� L)ai r �1 iriutr -- _ _ I(c rtc r srrrns Ballasts No of,Devic s or 1?tLury rlcnt No. Ilydrornassa(c k;lthtubs No of*VIolors hcrt;rl M11' Tvl_,cmn Ilimfd rtions %Vining: ,No . of 0cc ices or Cclrry len.l. O"1'CI[;iZ; r(ic h oIhlr omll b nrr m Is rc,lrrr,"d hi,the /uY/)c(for f ��Urn,ttcci V�Ihlc of Ilcctticai Work hen ic•(liuic'd l,c imillicip;d polio- ) y c�rlc i�•, `, l°°ST G"!d f A,.` Iitspe bons to hc• r�;rlu,..�e,i Ili rlcc�in cltuu c. `,,Illl r;I1-C' Idti!c� IU. rnd npoll complction. a I�r`�t. R kN F ( 1 GV; Villas "wvW by Hic: crrvwc nor pamo iA 0w pmlcmn"ncr_ n4Icc.;tHud r, mt nmy E, r, ti(_ II ccII1ecc pIo%Ikk:,, 1)1oc,l c>I•habiIIty I stunncc; inc:l,idin<, c:on11)1 atcd i,p°r;dtioi, (,r)vc,'rtt<,c or it , , II)stanlial cctuivalcl hhc Illidet ;ir"nc d cc;Oitic;v that such covc;rage it, in force iurd hM7 CNhitritc,, prooAWsandc; Ccr the Ixent7n i scmn;oi'ficc,. (11115 (VT li`JSHRANUF [I IVNI) ❑ Ol flank [ ] mcmrl ) I certi/i', c ider the puias n1111pellalties g1,pe1,j111y, 1/111t the il(fi)vlurtion oil dlis applicutiota r.ti Owe uIld complete. IA 101 NAi\I( �)� t tt td , 1AC. NNW 11 �...t _. _ _ 11,11C. 1,iccnacc`: Nr„rt Ar„�ln lrct >nt,,,,he, /i„c.) srl n rluir I ,. ...� _..._ Bits. i'cl. l N()(•„U 7`(k �y . ('/Ju/,/�I2rrb/c', r,Nr, All. Tel. � d_{c� d t^,... •, Pc:r MJi f c; I,�17, s 57-61, sectinty wo? rc.dAws Jklymmaq or Public 1;afc;ty 3" 1ma7r, ijo No. OWNFA'S liNS(AIANICT cvV:MEW I am aw:.tre f.hal the I,icenmoc clnc"rrot crow We li<thilit.y iusur4,n<;,c coverage. normally Ictluired by law. 1tv inv ,in n,ture� helo�-v, I bcrchv wtuvc; bias rcqun-cincla i mill the (c liccl,onc) ( _] oWncr [] owner's tWnfl.. si�m( aku iglat/l�crct l'p;'B 17CI"f tr�r: S --~ nr'c' Telephone No. Date.......4 . �... ......... L. of Nopr";'ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 88CHU . ..I s� Gat. s � r :................................................... i This certifies that ................ ...... �I � � �. has permission to perform ...IsJ , r ... ... ' wiring in the building of ..: .•...•• at t y � �� r7 ... Nort Andover,Mass. F ',�c� ............................... Fee..... F ... °...Lic:No. � ;..........L 1 ••••�• �� ELECTRICAL INSPECTOR Check# Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9/2.3/a l's 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) I(p AE:QQw ST C,oaq"pr j C' )614ot �S(y OF-Fie Owner or Tenant > tii-P lk)l a,tc _, LLC. Telephone No. Owner's Address r 5t) pl�;✓���Ft�',i714[ �y�c� SiE 2%� (��Y�i;r2 1 M C�I l Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building i( asll�(,s.® u l CZO ' 'ESN. Utility Authorization No. Fsicting Service Amps , / Volts Overhead ❑ Undgrd ❑ No.of Meters 6LOL-a- 1 �( ) Amps %�O/ , Volts Overhead ❑ Undgrd Q No.of Meters NUmner of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 6H A k�s ELA EE6" Con: letion of the lbllowin table inay 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 Above In- o.o mergency Lighting No. of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter Units No. of Receptacle Outlets No,of Oil Burners FIRE ALARMS No.of Zones No. of Switches No. of Gas Burners No.of Detection and Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 1 Totals: I I 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 No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:&' ` 1,5 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 N BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: GE:',-- ` LIC.NO.: %. J r` Licensee: 1CA01© kA , Signature LIC.NO.: S y M 2 (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:(M 9'7K Address: PC) zo)& 1 ly M&_r:wn Tl P,1H C3 ?) Alt.Tel.No.: tQ t)3•16•g9_9S' *Per M.G.L c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 1IZ The Commonwealth ofMassachusetts Department of lndustrial.Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwminass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILL,D WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name(Business/Organization/Individual):_ j-,` - 0 1 l,'S Addt'e55: _ City/State/Zip: Pbone#: ""W r' r, Are you an employer?Check the appropriate box: Type of project(required): Q I an,a employer with employees(full and/or part-time).* 7. RNew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10❑Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance oI are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance,I 6,❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other i 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Aryapplicant that checks box#1 must also fill out the section below showing their workers'corn ansation policy information -- t gomeowaera who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such, 1 tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I I aitt air einployer that is providing wor'lcer,s'eotnpeiesation ittsuratice fin•hey employees. Beloip is the policy aced job site inforneation. Insurance Company Name: �.1 Policy#or Self ins,Lic.#: `�° -- Expiration Date: Job Site Address: t\"` City/State/Zip: Attach a copy of the workers'compensation pokey-declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK.ORDER and a fine of tip to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herelrp certify under tlee N aints ant penalties ofpeijwy that the information provided above is tare and correct. Si mature: Date: 0'id. .�Jdat" Phone#: t� Official use only. Do not nvrite 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 4.1lectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ---� SE&DI-1 OP ID:JO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 09/21/2015 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(ies) 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 CONTACT Foster Sullivan Insurance NAME: John Dussauit 163 Main St. A/c°NN EXt;978-686-2266 FAX Ne:9?8-686 6410 North Andover,MA 01845 E-MAIL Foster Sullivan Insurance LLC ADDRESS:certificates@fostersullivangroup.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:MAIN ST AMERICA ASSURANCE CO 29939 INSURED S.E. &D.Inc.,Electrical INSURER B:TRAVELERS INSURANCE CO 19046 David Street PO Box 114 INSURER C:A.I.M MUTUAL INS CO 33758 Meredith,NH 03253 INSURER D:LIBERTY MUTUAL INS CO 23043 INSURER E:ESSEX INSURANCE COMPANY 39020 INSURER F:THE HANOVER INSURANCE COMPANY 122292 COVERAGES CERTIFICATE NUMBER: 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. IL TYPE OF INSURANCE DDL BR POLICY EFF POLICY EXP LIMITS LTR D POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT6109P 08/29/2015 08/29/2016 D aMAcETOREIT ED PREMISES Ea occurrence $ 300,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) S 10,00 A X BLKTAl WRITTEN CONTRACT PERSONAL&ADV INJURY $ 1,000,000 A X GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PROjECT P LOC $ -AUTOMOBILE-LIABILITY--- --- -- --- -- -- COMBINED SINGLE LIMIT..... _. -1}000 Ea accdent 5 ,000" B _ ANY AUTO BA0F132412 07/29/2015 07/29/2016 BODILY INJURY(Perperson) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE _S 5,000,000 E EXCESS LIAB CLAIMS-MADE XOBW5340714 08/29/2015 08/29/2016 AGGREGATE S DED I X I RETENTIONS 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N VWC-100-6017018-2015A MA 01/22/2015 01/22/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A --- D (Mandatory In NH) WC5-31S-389186-033 NH 08/29/2015 08/29/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 F CRIME 1834827 03/20/2015 03/20/2016 CRIME 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover,MA ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE `)0),aAfc ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ® � � ' wa �' 1� ,mlix� d�T t-LECTFt Df 'Or BURP I Cl A( S LSSUES„TILE FOLLOWING L I CCNS'E AS A REG.1.5TfRE`'D MASTER E{_ECTRICIAN CAiJ.:I`Ct STREET CLGCTRI C INC ` 17 AV I C! N <STRE F'O C30�f 1 lea NH 03753-0114 t�CRi"p ITL1 8362 Date ' . .° .. ......... � �, NunrM�tioOc TOWN OF NORTH ANDOVER a PERMIT FOR WIRING '88ACNUg� i This certifies that ..... . '.. ..... . has permission to perform � �� r. ..... 9f..r . y,- I wiring in the building of....... .r. ........ . .......................................... at ...... .�............................................North Andover,Mass. Fee.. 2.� ..............Lie. No.c /65.................................................................................... ELECTRICALINSPECTOR Check# °�� 3 i (flmmonweafilt of Vamackweffj 0 facial Use Only 2epaptinent of ire Permit No. ire Service.4 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (l,a,ebl,nk) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IN, ORMA TION) Date: '? I---)-. U ( G City or Town of-. ' A) 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)— Owner or Tenant Telephone No. Owner's Address L, Is this permit in conjunction with a building permit? Yes No F1 (Check Appropriate Box) Purpose of Building_ A t/,t t4 L, 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: JIh4 J Conipleiion of the following table inay be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above lvo—.-OTEmergency Lighting i1rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o f Detection and No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons..........I.N.W.-.11 No.of Self-Contained Totals: .... ............ Detection/Alerting Devices No.of Dishwashers Space/Area Heating I(W Local Ej Municipal F-1 Other Connection No.of Dryers Heating Appliances KW Security Systems:* No of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: S U (When required by municipal policy.) Work to Start: ( 4A AA,,.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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE n BOND [-1 OTHER E] (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Signature LIC.NO.: 2-7 73--(IF (1fapplicable,enter "exenint"in thq1#cense man er line Bus.Tel.No.: 73 1 '72 S" 17 6 Address: IJ S �Ei v-q- �- � L, 1 AILI C,-2 ��-3 Alt.Tel.No.: '7 A I g *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 El owner F1 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Fold,Then Detach Along All Perforations .COMMONWEALTH OF MASSACHuSET�`S j ® ® ® • - ® ® k1m lions W619j"Um BOAIR Of ELECTRICIAN.S ISSUES -THE FOLLOW[tJ;G L'1 CENSE .' AS A REG JOURNEYMAN :ELECTR FAN 1(E�f LN. M COXALL_ 128 PI • S'1 t�W NE• WA1_TI AM 1A o2453-86 27756 E ...: •'07/31.1,16 ... .: 81584 i Date... .......��..�..e:•..�. N i � OR7iy TOWN OF NORTH ANDOVER '- PERMIT FOR WIRING ,88AC14U5��1 4 This certifies that .................<.�".��........ 4 � .............:....... has permission to perform ... ... .....���t..'. ................... wiring in the building of..........�, e ". `� ................................................. a ��... ........:� �..e.'. � ... °.` .... ,North Andover,Mass. �i Fee...1.. .........Lic.No. .............. .. � ' ..... . .... .......... ............................. ELECTRICAL INSPECTOR Check# �'`fR f°•., u� OInt"'"01-1 ml alth of Massachtisetts 0I I IcIal t l.,c Orrly �I tt1 !°cmiii. No x: Department tof Fire Services ( % > ( r(ctslr,.tnc Itnd Ic(� l�,r�� ARI:) (.:)I. 1, NI:', I 1 IVFN HON FBI.(,) I.AFION�; 11071 (lc lvc hl(ritl<I APPLICA11014 FOR FIERRAIT "m PERFORM ELECTRICAL WORK i ra_.tl ( mle(fvlC( Ciyll( I /A K OR 7 Y /,,'A/,/ LNVO 11,I77O,A, r�h� � n )I"r��,� e� C'it)� of I'(rr tt of NORTHANN)(�t"1�;1Z lr) tlr,y Gr j / c , hp w urr(:I<.� .I tned jump IRr(I U 41AS or h a nrtclrt"I W Pak aII dw cIcc,uic,rl work dc's,Clh(A IIcImv, I,uc.rtiou (Slrcct o4 Number) k) •" . (lwcorr or l'enrrnf Own(Vs ,Udress )� p Is (Iris permit in ctrujrrnchon w0th a WWI �crinit:' 1 e� � No � � (Ch,ck Approlrriniv Box) t�6�n w w�t JN"1(._ 1 . I'nrposc ul'fiuildin<, [ $� tm. �t1 )fit^'_ t na, ,ty°� ,"s - l�tilil�' wutlrtrrFr,:r(ian No. O ( _I ,rd No. of iAIt°tcrr, hwiwtin<r ,��crw ice _ Antp�, / Volkvci he;rrl � l ud" . ('ra erl rcl Not of A b?"s — Nrn(rlwr of f'ccdcr',v and ,lntl I uc,rtioo and NtrturT of"I'roposed I?lecirical Work: In tit l I V s No. of Ner r t s No, of(,I'll. u�s r. f addle far 1'itrusforrrrt.r s Tot I�riltr olrtt"Lie�i�trnczl bt tlra� / -- 1 ` 1 ( ? irs Total rssed f.unrrn,tr 1 ` e No, of I minair'c 01111Cts No. of I�lo( FIIbs if;cnr r rtors K V A No. ul I,uitrnrairvw `"'wwuuinin;: I`ool t�rl�ttlr � � �wrnrl. � � I nr(Irtrt �i�rrFcn cy I,it;Ttilntr to t fkl? �1,��\IxNIS No , ofzonr - o. ufOil I�urrt f,' vn. (tl I:tcr^ tf rr fe Outiclw �N No. of 1,eO (,llvs , - �No. of I)etcctiorr troll � No, of (,as Iyorocr, � (urfrtrtnt��l)cw roes No. of R any es No. ol'AN ("ontl. I orrTol��,f �'No, of %lerfing Im icr�,,.. st( 1)t,spost rs lla rt I'unr t iNunrb( r I one, I(.�� Vir. o( sitlt ( orrtrrued No. of 1� ,r� I ot�rl�p . )oe-cf er Iron/\It tiou )rw ivi s No. of )rshw srcrs - — NMunrrtp(r9 � ( orrnt t tiara � ) O(her .. IN i . of I)rc( rs I ( rturt; 11)plia11cc sectrrrty yattnrti: No, of 4V';rlr r o _ -_No rrf�7tvrcts rtr l;yury rlr rat (N I Iea l( r s KW of No. of t)rrt r Wu irrr s,i�wns 13all.Isis No, of"I)tvrtts orjalrrrw rltrrt No. flydi-onlasslu"v 13rthtubs No ofVlotor's I"otal Ill' �'(�Iryorohrlr)c�rcc (orral4l"iris Iruvalent O 1 1 IPAQ ........ m etc lv(I i I�cd ht Ihw hr',ywc'tnr u/ I"stur�,.rtc�I Val(ic ol,I:k c,tric�rl Work 0 licir icqmwd 1)v nrunw Iprti polic,y.) ol1\ iu `;I<ui c i. .r tk ( In x-c.(ioils to hr r,(Iu. ,l1 I rat ;I ruril,IIIC(, mill `/III Itinle 10) utd tapoir �` (_T. (1) I,I(, ( (,ittlwlc t (rn. NS RA � -._. rl,. I,ii11c,,S lw",alVfJll hV t1C lYtvi"ICI no l7t`I hill IItif tIYC' 7t.'i R Intanl C Ul t'IV cU ICtl 1101-1: illm fstiLK.' Iiltli;u t1w lir ewcc prow Idcs prool'ol'liabilil� illsrlr,rnC(: inc.ludnu; c(mlpjoli rl C,hc:I.Uion' �.(tw�(„rtts,e or its.,ubt;t<:r�,(itrl cquivalcrrt 1'11c tlncl(l of_`JlCd (;(atilw that stmlt is in 1,61ce, ,uul Ims c�ltihitcd ln(rr,rf ul s�urtc; t(r (lie permit issuing;o(llc.c, ( 1WUK (AR IN`WRANCI? [] HO NI) (j Ohllh;lti [ _1 1`+pc(.i('y ) C cel'ti/j,, middle the poilis um1 pejuillies of p,ijttrt,, thw the In fi)rvrrtttinlr oll this ltpplicntialr is ti-lie nrrrl Complete. icc0�I(���A��Ik IA ` O.: /Jntat�/rc<rhlc, ��rt(i� ' xenj[' uthmw. u.s:trtnrth<rlin�.) Sigh rturt °„ � _I;u I"f(. ENO : .11s i :__._ k. l'r t r ".:.I ) ( _ _. ___----- ---- e . N r �ddress: �°�t�. (�"r � 1 t t� l l ! I I. No.: _l._. Alt."I'c Tei M 1 1, a I'17 s �7-61, ,sectirily wort: requires Department of I'rihlic >Ilety 5" I,icerise is No. OWisdVR'S INSTIRANCL VVAIVFR: I mrt awwaw, thtrt tlw I,ic,ms.(•r. dm.v mu hmv the liahilit:y iit,,ru,.rrtce covcI-ag-C noritrctlly w('Jitiicd by k1w I3y illy sl,;mtturc helow, I herehy "wive dus ruyuirmums. I alit t1w (cheek erne) ( -] oMwncl [_] Mviler's Owvntr/\germ `gig""Rare Telephone No /'/'R All T f kL S / e Berry Street Project 9/17/2015 Plumbing Permit Fee Sq. Footage %Sq. Footage $ Fee For of Each Building of Each Building Each Building To Total Based on % of Sq. Ft. Building 1 52824 17% $9,878.00 Building 2 96961 31% $18,013.00 Building 3 76748 25% $14,527.00 Building 4 77506 25% $14,527.00 Clubhouse 5860 2% $1,162.00 &Shed Total 309899 100% $58,107.00 Date , . .... NORTH 1� TOWN OF NOR A NDOVER ING o� ,88ACHUg� fies that This cerh ,� .. ................... 0 J y E Qi' 4 G permission to perform ....... 9 ............................ w�1rig in tl�building of over, ass. F [ O at ..`.... � �>' � 4;..... """""'......... � 9 � •:....$:.... ........ SPECPOR f Fee . ......... ...... Lic.No._................. ........ E�EcrRicnL IN t i Check# � 9 Commonwealth of Massachusetts Official Use Only -rnit No. o Department of Fire Services Pei Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: location tndersigned givesnotceof his or her intention to perform the electrical work described below. (Street&Number) Owner or Tenant `sTelephone wj Owner's Address Is this permit in conjunction with a building permit? Yes RY, NoE] (Check Appropriate Box) Purpose of Building 6,AIJ Ly,i j�J=ef— t�,'jjz� Utility Authorization No. Existing Service Amps Volts OverheadF1 Undgrd El No. of Meters New Set-vice 241(.'A� Amps / 2"a�?, Volts Overhead R Undgrd RK No. of Meters Niiiiibei-ofFeedet-saiidAiiipacity Location and Nature of Proposed Electrical Work: Completion of thefiolloiringtable may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceill.-Susp. (Paddle)Falls No. of Total .Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above D 11 ❑ ot Emergency Lighting grnd. grnd. Battery Units — No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting Devices Tons No. of Waste Disposers Heat Pu Inp Number Tons KW No. of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 Municipal [:1 Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Water No. of No. of No.of hevices or Equivalent KW Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydroinassage Bathtubs No. of Motors Total Telecommunications Wirii r: �17P7771 No.of Devices or EquilvIent OTHER: Attach additional derail if desired, or as required ky the Inspector of 1,11ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE D BOND [] OTHER [I (Specify:) I certify , under the pains and penalties ofpeijwj�, that the inforniation on this application:is true and complete. FIRM NAME: , A' j LIC. NO.:— Licensee: '-',,"�,,J�0 i,\ 'j�-Q,, e LIC. NO.: r Signatull Address: applic A able, enter "exemp�� t"in the license number 1.) -%2-12, Dl,b72 � o Ij Alt. Tel No.:(-Q()`� o'.,49'ls *Per M.G.1,c. 147, s. 57-6 1,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 covet-age normally required by law, By my signature below, I hereby waive this requirement. lani the(check one) [1owner [l owner's aTent. Owner/Agent Signature ,Telephone No. PERMIT FEE. $ / U