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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number �le(�— Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 40442
MAY BE OCCUPIED AS G IN AC
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
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a CERTIFICATE ISSUED TO
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ADDRESS
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Building Inspector
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Date ....... .... 77:' ........... if
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...........KL L ezgo............................. n ... ..........................
has permission to perform ...
..................... ......................................
wiring in the building of ............AM -40 ../,/)
....................................................................
A
at.. .............................. 0� �dover, M
..............
Fee ..................... Lic. No. .......... . .....
EL AcrRI�C;A�LINSP***R*
Check #
10494
Common -wealth of Massachusetts Official Use O®nl�y
r Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07) (leaveblank
UV. k
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code MEC), 5 7 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: L �_
City or Town oh NORTH ANDOVER To the lnsp etor ol Wires: �
By this application the undersign`edI gives no' e of hiq or her intention to perform te ectricaI work described bel
Location (Street & Number)
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjanctiomwith a buil 'ng permi . o ❑ (Check Appropriate Box)
Purpose of Building Ye 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 1
Lo ation and Nature of Proposed Electra cal Work: r�z' ( -X- r C i t
rmmnletinn nfthe fnllnuino tnh1A6nv he waived by the Insnector of Wires.
No, of Recessed L„n'�^aires
No. of Ceil: cusp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above 1:1'I a- El
nd. rnd.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
F1:PX ALS odMS
No. of Zones
No. of Switches
No. of Gas BurnersNo..of
Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total Tons
No. of Alerting Devices
No. of Waste Disposers
p
Heat Pump
Totals:
-...'. Number
"..'.'
Tons
*. * ..*".......
KW
...........
....
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
. Heaters
No. of No. of
Signs Ballasts .
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated ValjlA
f'cal Work: �/� (When required by municipal policy.)
Work to Start:j Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO E: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insugance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such =BONDE]
is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OTHER ❑ (Specify:)
I certify, under the ai sand penalties ofpje�rjuury, that the information on this application is true and complet
FIRM N J; =; c✓ LIC. NO.: vm
Licensee: C AA Nr"j ir"ignature LIC. NO.:
(Ifapplicable erg r " mpt" in the license number I % I Bus. Tel. No.•
Address: V e D Alt. Tel. No.
*Per M.G.L c. 147, s 57-61, secu ty 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
�: ... _ WT.. PERMIT FEE: S
____ C9 - it
The Commonwealth of Massachusetts
i Department of Industrial Accidents
Office of Investigations
600 Washington Street
;' .
4 Boston, MA 02111
www.,omss gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Nall a (Business/nrvan;,,at n
Address:
City
Phone #: .
Are an employer? Che ppropriate box:
1.
Type of Project (required):
I'am'a employer with
4, ❑ I am a general contractor and I
6. ❑ New construction
employees (full and/or part-time).*
2. ❑ I am.a.sole proprietor. or partner-
have hired the sub -contractors
listed on. the attached sheet. t
�• ❑ Remodeling
ship and have no employees
These sui3-contractors have
$. ❑ Demolition
working for mein any capacity•
[No workers' comp. insurance
workers' comp. insurance.
5. El We are a corporation and its
g, n Building addition
required_]
3. ❑ 1 am a homeowner doing
officers have exercised their
lo -EI -Electrical repairs or additions
all work
right of exemption per MGL
I I.[] Plumbing repairs or additions
myself, [No -workers' comp.
c. 1.52, § 1(4),•and we have no
12,0 Roof repairs
insurance required.] t
employees. [No workers'
13•❑.Other
comp. insurance required_]
'Any applicant that checks bo)l# l must als fiat h
0 out t e section below snowing their workers compensation policy information,
t homeowners who submit this affidavit fndicteing they am doing all work and then hire outside contractors must submit a new'affidavit indicating such.
#Contractors that check this box must rttacbcd an edditioral sh5ct showing i_ho nate of the sub-cantractors and their �verkass' ren p, potty :nfo, �.adon.
I arg an eaysployer that ,S.prova e�ig:t�o, fieri' co�ia�er�sea �e ar�saaracaee oP cam? ePnplOyees: Bel®w is the policy and job sate
inforrnallom •'
Insurance Company
Policy 4 or Self -ins. Lie.
Expiration
Job Site Address;/State/Zip: i
Attach t�r---
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 Iead to the imposition of criminal penalties of a -
fine up to ,$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify u er the pains and penaltiesyf pf fjsfy that the informatio�t provided alpVeistweand correct
Official use only. Do not write i Lhis area, to be canip14ted by nUy or town official
City or Town:
Permit/License
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electric
6. Other al Inspector 5. Plumping Inspector
Contact Person: Phone #:
No, c Date...........
1, J i ' ...........
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
o
i_
`y 11 �!�
This certifies that........ '. : �. +1 ... �.. - c...........
has permission to perform)A-�r....�.�•-c-�
wiring in the building of � ��
at -.�K...f-<-f.:.......t ............................. .North Andover, Mass.
n
Fee.Z ...p7i ....:....... Lic. No!f..� k+.�...............................................................
ELECTRICAL INSPECTOR
09/17/98 11:13 75.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use Cnly,
Permit NC - —Z
r� eannxtr�nv�L�T� Ir, ss�e„r�s5 ms's �
F Occupanc/ & Fee C ieciced,�_
BOARD OF FIRE PREVENTION R (ZION,' 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts E!e=cal Cade 527 CMR 12:00
(Please Print in ink or type all information)
The undi
• KII
Owner a
Owner's
Town of North Andover
To the Inspector of Wires:
Is this permit in conjunction with a building permit Yes f� No ❑ (Check Appropriate Box)
Purpose of Building_ ( %� '0 �, _!!::4 Utility Authcrb=dcn No.
Existing Service Amps Vcits Overhead ❑ Undgmd ❑ No. of Meters
New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters
Number of Feeders and Ampacily
- 1.1
and Nature of Proposed E.ieariral
!/ I/ �<
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massacnusetts General Laws
I have a current Lability Insurance Polic/ including Completed Operations Coverage or its substantial equivaten YES NO =
valid proof of same to the Oftfce YES = NO = If you hive checked YES please indicate the type of coverage by checlong the appropriate box
�gnl
= BOND = OTHER = (PeaseSpecify)�r ,l"560(Expvatlon Octel
u f E3ecictWo l
Work to Start / / Inspection Date Resquested Rough Final
Signed under nattles periury:
FIRIA NAME LIC. NO.
Ucansee ( _ V �4 i ��S 1 s'�Gj th 1 P�.(/�Slgnature UC. NO.�%
Bus. Tel No. w 3^ `� 6 �� -
Address / lJ /� �C J X E%� 0
3//Ci Aft Tel. No.
OWNER'l INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Maasacnusens
General Laws. And that my signature an this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE 5�--
(Signature of Owner or Agent)
Total
7htfing Outlets
No. of Hot fuse
No. of Transformers KVA
Q
I
in C
.ignang F7xtures /
Swimming Pool and
4 C
gbove
and G
Generators KVA
No. of Emergency Lgnang
Receatac:es Outlets
I No. of Oil Burners
Sattery Units
_ Switch Outlets
,V
No of Gas Bumers
FIRE ALARMS No. of Zone
Total
No. of Detection and
No. of Ranges
No of Air Conti
Tons
Initiating Devices
Heat Total Total
No. of Mooaal
No. Pumas
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
I Soace/Area Heaana
KW
DetectlonrSounding Devices
C Municipal C Other
No. of Orvers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Signs
Bailases
Winn
No. Hvdro Massage Tuds
I No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massacnusetts General Laws
I have a current Lability Insurance Polic/ including Completed Operations Coverage or its substantial equivaten YES NO =
valid proof of same to the Oftfce YES = NO = If you hive checked YES please indicate the type of coverage by checlong the appropriate box
�gnl
= BOND = OTHER = (PeaseSpecify)�r ,l"560(Expvatlon Octel
u f E3ecictWo l
Work to Start / / Inspection Date Resquested Rough Final
Signed under nattles periury:
FIRIA NAME LIC. NO.
Ucansee ( _ V �4 i ��S 1 s'�Gj th 1 P�.(/�Slgnature UC. NO.�%
Bus. Tel No. w 3^ `� 6 �� -
Address / lJ /� �C J X E%� 0
3//Ci Aft Tel. No.
OWNER'l INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Maasacnusens
General Laws. And that my signature an this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE 5�--
(Signature of Owner or Agent)
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 424-2012 Date: DECEMBER 14, 2011
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 451 ANDOVER ST, SUITES 335 North Andover,
MA 01845
KALEB PAN, LAWYER'S OFFICE
MAY BE OCCUPIED AS TENANT FIT -UP IN ACCORDANCE WITH THE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER
REGULATIONS AS MAY APPLY.
Certificate Issued to:
Fee: 100.00 PREVIOUSLY PAID
Receipt: 24826
NAOP, LLC
451 ANDOVER STREET
NORTH ANDOVER, MA 01845
Building Inspector
LaGrasse & Associates, Inc.
Architects, Engineers & Lana Planners
Architects
Joseph D. LaGrasse, AIA
Thomas F. Galvin, AIA
Julianna E. Hoch, RA
ARCHITECT'S CONSTRUCTION COMPLETION AFFIDAVIT
Project Name: North Andover
,J
Project Location: 451 Andover St CP "� Is
Name of Buildings: North Andover
Architects Project No: 2301
Nature of Project: Interior space u
In accordance with Section 116 of the Mass
I, Joseph d. LaGrasse, AIA Rei
Tb h
Being a Registered Professional Architect hereby certify that I have provided construction observation
services on behalf of the owner, that I was present at the construction site on a regular and periodic basis
and that to the best of my knowledge, information, and belief, the work of the project has been executed in
conformity with the documents approved for the building permit.
To the best of my knowledge, information, and belief, the work of,
❑ Interior floors, walls, & ceiling construction work have been satisfactorily completed in accordance
with the construction documents.
One Elm Square
Andover, MA 01810
JDL-Construction Completion Affidavit
T 978.470.3675
F 978.470.3670
www.lagrassearchitects.com
LJ Name
oseph D. LaGrasse & Associates, Inc.
IZ�1.�If
Date
1420 Celebration Blvd.
Celebration, FL 34747
AA26001333
JDLaGrasse & Associates, Inc.
Architects, Engineers & Land Planners
Architects
Joseph D. LaGrasse, AIA
Thomas F. Galvin, AIA
Julianna E. Hoch, RA
ARCHITECT'S CONSTRUCTION COMPLETION AFFIDAVIT
Date
Project Name: North Andover Office Park, LLC
Project Location: 451 Andover Street, Suite 335, No. Andover, MA
Name of Buildings: North Andover Office Park
Architects Project No: 2301
Nature of Project: Interior space plannine & build out for Lawyers office.
In accordance with Section 116 of the Massachusetts State Building Code, 780 CMR -8`h Edition
I, Joseph d. LaGrasse, AIA Registration No. 4153
Being a Registered Professional Architect hereby certify that I have provided construction observation
services on behalf of the owner, that I was present at the construction site on a regular and periodic basis
and that to the best of my knowledge, information, and belief, the work of the project has been executed in
conformity with the documents approved for the building permit.
To the best of my knowledge, information, and belief, the work of,
❑ Interior floors, walls, & ceiling construction work have been satisfactorily completed in accordance
with the construction documents.
One Elm Square
Andover, MA 01810
JDL-Construction Completion Affidavit
T 978.470.3675
F 978.470.3670
M
Name
qoseph D. LaGrasse & Associates, Inc.
Date
www.lagrassearchitects.com
1420 Celebration Blvd.
Celebration, FL 34747
AA26001333
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