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HomeMy WebLinkAboutMiscellaneous - 1 EQUESTRIAN DRIVE 4/30/2018 (2)N O o m c Qm o CO a m z o � o < o m Date TOWN OF NORTH ANDOVER I . . . . . . . . . . . . . . . . . . . . . . . . . . PERMIT FOR GAS INSTALLATION This certifies that. S "O -e 4pw � f ....................................... has permission for gas installation . . �. . ............. 9 in the buildings of .... 14-1 -0 b.b --e "t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . t (�f(�. .4�� ........... North Andover, Mass. Fee .� �J.- Lic. No. �� 3.6 ... ....... Axz�cjq.. GASINSPECTOR Check# /-� -7,7 8449 v MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY "1!� /a ,v MA DATE`' / t- PERMIT # JOBSITE ADDRESS % U OWNER'S NAME OWNER ADDRESS _r- . ., ..s,.l!? �`^- 'e TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: [j RENOVATION: REPLACEMENT: 0J PLANS SUBMITTED: YES F --1j NO -�_I APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER:.. T �- BOOSTER CONVERSION BURNER COOK STOVE.- DIRECTVENTHEATER =:1 -----.-j—_ DRYER FIREPLACE FRYOLATOR ,J _ �I _ _ ( _ _ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN . - -- --.r _ POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST I _ I --.I i UNIT HEATER V UNVENTED ROOM HEATER Ih i —)AL i— WATER HEATER OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES JaINO 0 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY —a OTHER TYPE INDEMNITY © BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT �J SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true,and accurate to the be§t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliiaancee th II P inentiSrovisyn of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C<✓ ' - PLUMBER-GASFITTER NAME ` -. S - : ..--...---_ J LICENSE # F121 3_& IGNATURE MP ED MGFEJ JP n JGF LPGI CORPORATION 9# _3.3_'-/._ j PARTNERSHIP O(# LLC . i#� COMPANY NAME: ADDRESS ,►�!�' y �f jj _ CITY �1 .!/���I U �,�'''`— _._., _....-.W.-- !► STATE ZIP -i aflITEL c. 7 GF . - -✓ _� FAX CELQ/1:73 _ . EMAIL O z z 0 F U W W a z� O y� r W � ~ W co a w w N a zO a a a U � J F,, a a � Q c ui x w H O z 0 H � U a 1 a 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kwi. 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address City/State/Zip: Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ElI am a general contractor and I employees (full and/or part-time).* 2. ❑ have hired the sub -contractors 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.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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. Insurance Company N Policy # or Self -ins. Lie. #: Expiration Date: lob Site Address: City/State/Zip: attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ,ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a me 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 )f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 'ignature: Date Ujjicial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www,mass.gov/dia Location Z f7 No. Date f.-, � - � - -, jr��IiL I Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building lnspecto&7 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Section for OffiCIAi:USC BUILDING PERMIT NUMBER: !� DATE ISSUED: SIGNATURE: Building Commissio r/I 'a r of Buildings Date _3 - SECTION 1- SITE INFORMATION LI Property Address: 1.2 Assessors Map and Parcel Number: - I a S -D O I Map Number Parcel Number 1.3 "Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ r, SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Scfvicc Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: S X Ci Ll S License Number z/ Yew; i7 AtJE N• RN�60;- Address _ Expiration Date S e Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 1� FrN Ccw"5f1 ,LIC-+ a f -j Company Name /,5213123 Z (/ C w 1 ff IV,14 ijA Vin, Registration Number Address ZQ t Expiration Date Sig i Telephone SEC'I'10N 4 - W VKIM LbMJ v1�ir�i�Jn a ivl. �,., .�... , _ _� , be and submitted with this application. Failure to provide this affidavit will result Workers Compensation Insurance affidavit must completed in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 2 T- rn ©� L Ex ,7 �on� � ,•� �1�SEvn� SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFRCIAL,USE ONLY Completed by permit applicant..: 1. Building �j (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee (,) x (b) 1 or 4 Mechanical (IIVAC 5 Fire Protection Check Number 6 Total (1+2+3+4+5 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property I , Hereby authorize 'N E c It/ --' to act on My in all n t ative rk authorized by this building permit application. --D Si of Date SECTION 7b OWNE. AUTHORIZED AGENT DECLARATION Owner/Authorized Agent of subject I ,as property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name signature of Owner/Agent Date 111,11, NO. OF STORIES SITE RD BASEMENT OR S1,AB ST ND 3 SITE OF FLOOR TIIVIBERS 1 2 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1 -MIGHT OF FOUNDATION THICKNESS SITE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND �,��rimnrr.r�'rn ATA'T'TTDAT [ AQ T TXTT~ - m m m 0 m Im I I y C � O 'O O CD Z H CL o �, CL CO) -moo o C.) O 0 CD CD o .7 cr d CD CD O CD C CD y� CD CLO CO) � O CD C2 H O CD 'O Z O CD C CD O 10 FA cn V J O cn O cnH m � CA _ CO) mC9 y�rny T CO2 O � m a m � c • O 7 0 C W �'fl o EL C•N O Q n EL Co d O � Cri � 7d E = =a wG -1 m t7 . n O Z H r dM A �'O �.� CL .� a mgmvoi O ? O > >mo; CO �o 0 o ZS.� H O 0 O CID C. N a O: CrJ CL iC O ? ? O c CoCD �y C N N d d N �» < m V) �J CID -1 O o =—o V JG C: O CD =r O CID O �3 -0 z CD r. moCD: W a3 y : Q. m oCD od: c.'oCl. .nom: 0 c=:,: o m � CA _ CO) mC9 y�rny T CO2 O � m a m � c • O 7 0 R ° EL n EL �. � Cri � 7d ?'. wG .� to � � EL 5 r dM A a g7 w H 0 0 c z BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 r Birthdate: 03/24/1943 Expires: 03/24/2002 Tr. no: 18312 Restricted To: 00 KENNETH B KEEN 21 HEWITT AVE Z2" —e4� N ANDOVER, MA 01845 Administrator ��ie i�omnearu�eall� o�✓l�+�aor% HONE IMPROVEMENT CONTRACTOR Registration 108363 Expiration: 8/18/02 Type: 089 KEEN CONSTRUCTION CO. Kenneth Keen ADMINISTRATOR 21 Hewitt Ave No. Andover MA 01845 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/oi one years' imprisonment as well as civil penalties in the fornj of a STOP WORK ORDER and a fine of $100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the fiins and penalties of perjury that the information provided above is true and correct. Signature Date Z Print name 6_A),o e- th • ,/t e e .. j .. .. ...... . . ... _ ._..._._.. Phone # official use only do not write in this area to be completed by city or town official ;.. -. . city or town: permit/license # -Building Department - C] ❑1,iceosingBdard'check if immediate response is required []Selectmen's Office Health Department contact person: phone #; -Other _ The Commonwealth of Massachusetts iV Department of Industrial Accidents Office ofinivesgoolfts 600 Washingaton Street Boston, Mass. 02111 rr Workers' Compensation Insurance Affidavit Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/oi one years' imprisonment as well as civil penalties in the fornj of a STOP WORK ORDER and a fine of $100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the fiins and penalties of perjury that the information provided above is true and correct. Signature Date Z Print name 6_A),o e- th • ,/t e e .. j .. .. ...... . . ... _ ._..._._.. Phone # official use only do not write in this area to be completed by city or town official ;.. -. . city or town: permit/license # -Building Department - C] ❑1,iceosingBdard'check if immediate response is required []Selectmen's Office Health Department contact person: phone #; -Other KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691.5201 Webber, John & Caroline 1 Equestrian Dr. N. Andover, MA 01845 (978) 689-2566 Contract #1518, Appendix A Date 03/01/01 Remodel existing family room: • Sheetrock existing family room (approx. 750 sq. ft.) • Tape & seam walls • Create closet near electric panel • Square off corner going into boiler room • Install one 2'6" x 6'8" full louver door going into boiler room • Install two 2'6" x 6'8" 6 -panel hollow core smooth masonite doors to access crawl space • Install one existing 3'0" x 6'8" 6 -panel pine door going into electrical room • Replace 5'0" x 6'8" exterior door unit with one 3'0" x 6'8" exterior 2 -lite door • Install 2' x 2' revealed edge suspended ceiling throughout finished area • Install carpet throughout finished area ($1500.00 installed allowance) • Install ceramic tile at back door ($60.00 material allowance) • Frame & insulate kneewalls, create shelf on kneewalls • Install trim on doors, windows, and base to match existing in house • Paint walls & trim (2 coat finish, 2 neutral colors) • Enclose lally columns with primed pine Plumbing: • Install washing machine hook-up at exiting soil pipe($1000.00 allowance) • Move gas line to new laundry area • Move existing sillcocks to facilitate wall board Electrical: • Install one zone of electric baseboard heat • Install outlets to code • Install 14 recessed light fixtures in ceiling ( switched on dimmers) • Install one outlet near new laundry area • Install one cable outlet and one telephone outlet • Install one switched keyless light fixture in electric room Price does not include permit fees or wet bar, entertainment center, or fireplace. All extras to be paid in full when ordered. Total Price: $16,840.00(sixteen thousand eight hundred forty dollars) Payment schedule: $5600.00 due upon signing contract $5600.00 due when rough frame & electrical is complete $2000.00 due when sheetrock is installed $2140.00 due at completion of work except flooring $1500.00 due at completion of contracted work Customer Kenneth B. Keen Date Date 2012 Massachusetts Electrical Code Amendments 527 CMR12.00 § Rule 8: in accordance -with ftpiovisions of M.G.L. G. 143, §, 3L, the permit application form to provide notice ofinstallation ofw1ring sh all be urfforin throughoutthe Commonwealth, and applications shall be filed' ba the prescribed form. After a permit application has been accepted by an Inspector ofWires aplointed pursuant to M. CT.L c. 166, § 32, aa eleGtrical permit shall be. issued to the pers.on, firm or corporation stated on the permit application. Such entity shall be responsible for the notification. of completion ofthe work as required in M.G.L. o. 143, § 3L. Permits shall-belimited as to thetimr, of -ongoing construction activity, and may be.deemed-bytheTnspector-of-W-kes abandoned-and.imy-alid-Zhe— or sholias determined tl�� the authorized worl� has not commenced or has not pro'gressed during the preceding 12 -month period. Upon written application, an extension oftime for completion ofworkshall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the� permit application. Th e Permit Extension Act was created by S ecti on 173 of Chapter 240 ofth a Acts of201 0 and extended by S ections.74 and 75 of Chapter 23 8 of the Acts of 2012. 'Ihe puTp ose. of this act is to prornote7j ob, growth and long-term economic recovery an d the Permit Extension Act Ruffiers this puip os e by establishing an automatic; four-year extension to cortafirpermits -and licenses conceniing theYs c or development ofreal prop erty. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval thdt was "in ef(bot or existence' during the qu'alifying period beginning on August 15, 20 0 8. and extendingthrough August 15, 2012. 'T� file 8 —Fermit(DAte Closed: -5,:� 2z — /,5/, *** Note:)Reapply for new perm 6Permit Extension Act — Permit[Date Closed: 5-- 12- - ICK Date. ef 1-6 .......... ........ ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... has permission to perform ..., r7r ..... ........ I-- ­ V wiringin the uilding of ................................................................................... ... ...... . No h at ... rt Andover, Mass. .......... Fee ....... Lic. No 3.,7 ............. ? ELECTRICAL INSQr Check # 6 t" 0 " �' )- i N Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 4°`S BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] 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: 5/1.2/2006 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) ]Equestrian Drive (honer or Tenant Caroline Webber Telephone No. 978-689-2566 Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Utility Authorization No. ' Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: replace 2 light posts (post outlets not installed), install 2 nearby gfci outlets, replace 2 garage lights. Completion of the following table may be waived by the Inspector of Wires. i No. of Recessed Fixtures No. of Ceil: p (Paddle) Fans SusTransTotal of TTrsformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above❑ ❑oEmergency Swimming Pool rnd. Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. In Detection and of InDetection Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: J.Number Tons J.K.W No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Sec No of Devices or Equivalent No. of Water Heaters KW 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 if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Estimated Value of Electrical Work: TBD (When required by municipal policy.) Feb/2007 (Expiration Date) Work to Start: 5/10/2006 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Kelly M. Casey Signature LIC. NO.: 37200 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut, Mass 01826 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FPERMI FEE: $ I.S,00 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of 'Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm. or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of -ongoing construction activity, and may be.deemed by the -Inspector -of Wires abandoned and invalidif he --- or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. n The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections 74 and 75 of Chapter 23 8 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this puipose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence� during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. • Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0 • Permit Extension Act — Permit/Date Closed: 0AI Date ..... -04 ............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. ..... 67' Fr�/ ................................. 6 permission to perform ... 61q�� ... ) wiring in the building of ....... ........ 1.4., j k k e e., - e.- � R . ............... at ....... I ..... Ft.- VC-I-.rR fiqv. ........ ............. . North Andover, Mass. Fee ... 34.!� Lic. No. ......... .................. .... ..... ELE&RICAL INiPECTOR Check # 4 k 4f\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 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: 8/31/2006 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 Equestrian Drive Owner or Tenant Caroline Webber Telephone No. 978-689-2566 Owner's Address Same Is this permit in conjunction with a building permit? Yes ❑ No X (Check Appropriate Box) Purpose of Building Existing Service Amps Volts Utility Authorization No. 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: replace current sub panel with new sub panel. Cmmnletion nfthe. fnllowino tahle may he waived by the Insneetor of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners of No. In Detection and InDetection Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers HeatPumpNumber Totals:Devices Tons......... KW.......... No.Detection/AlertingofSelf-Contained No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal El Other Connection of Dryers Heating Appliances KW SteNo. SecurityNo. 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 of Devictes or E uivalent OTHER: Attach additional detail ij desired, or as required oy the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/2007 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 8/31/2006 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: I I n LIC. NO.: Licensee: Kelly M. Casey Signature '� LIC. NO.: 37200 (If applicable, enter "exempt" in the license number line) � Bus. Tel. No.: 978-697-4453 Address: 700 Robbins Ave Unit 3 Dracut Mass 01826 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 30.00