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HomeMy WebLinkAboutMiscellaneous - 1015 FOREST STREET 4/30/2018 (2)N � O .� J � m oma' �A m o -� OF IAORTM 4ti O � o O p 5 �ySs CHUs��< Date ...: TOWN OF NORTH ANDOVER 1 PERMIT FOR WIRING This certifies that .... has permission to perform .. /1r.r.7-4 wiring in the building of ...... � U-T!�7 .................. at.. S !:....... , North Andover, Mass. Fee . Lic. No. n ......f ELECTRICAL INSPECTOR Check # p��,sy 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: in accordance-with theprovisions of M.G.L. c. 143, §. 3L, the pemmt 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 ac electrical permit shall be issued to the person, firm cepted by an inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an 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 shalLbe limited as to the time of ongoing construction. activity, and maybe deemed bythe,inspector-of_Wares abandoned_and.invalid.if-he—. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the. permit application. The Permit Extension Act was created by Sec ' n 173 of Chapter 240 of the Acts of 2010 and exte�d� by 9►'ctions.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four yeazs beyond its otherwise applicable expiration date, any permit or approval that was "in effector existence" during the qualifying period beginning on August I5, 2008.and extending trough August 15, 2012. Rule 8—Permit/Date Closed: Dote: Reapply for new permi 0 Permit Extension Act—Permit/Date Closed: /L] .. Commonwealth of Massachusetts Official Use Only Permit No. / f Department of Fire Services Occupancy and Fee Checked 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 (MEQ), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: -I" 3 y -)A City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notiform t electrical work described below. /0/rce of 's o her intention to per1® Location (Street &Number) If i� / :5, -- Owner /-' Owner or Tenant jl/C X, 9 i X -F Gu ?I UYN Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No E] (Check Appropriate Box) Purpose of Building 45, AIG LL= /' Utility Authorization No. Existing Service Amps / Volts U Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ) (j Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters MW I I table may be waived by the Inspector of Wires. No. of Recessed LuminairesNo. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of LuminairesSwimming Pool Above ❑ In- Elo. rnd. rnd. 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 No. of Detection and Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices No. of Waste Dis posers P Heat Pump Totals: Number Tons '=­*­** ­ * KW — '­­ ** No. of Self -Contained Detection/Alerting Devices No. of Dishwashers / S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Cyonnection No. of Dryers Heating Appliances KW Sec . 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 No. of Devices or Eq u valent OTHER: 1 ,boa Attach additional detail if desired, or as required by the Inspector of Wires. Estimated a ue of Electrical Work: (When required by municipal policy.) Work to Start: _,7__ �_ ),)-Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover e ism force, and has exhibited proof of same to the pe itt ,suing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties of perjury, that the information on this appf ication_u true and complete. FIRM NAME:. Ic Z2,413LE LIC. NO.: D �� Licensee: zeeAtl 1,L4WEPI 0 Signature �' LIC. NO.: P15 (Ifapplicable, enter��//"exem� ,tt�",,n' the lice j�umberee.)n',/� r Bus. Tel. No.: 9�� Address: I . W1 11 Y -Xl 11/ "AVE l� � fav'" �!� N ^ �� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Saff&v "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. ,j;rl ?135 ,WO . 72�sseu�•-� �'a�edN� ] �e-xnspsef�ox,xequixeci'(��dAD) � ( � COMMON l7n�neeforrt'isn✓+aEuze• %o �ifia7s� Pate 3'asse��-- [) �`afSet�--r � � ate-�ns�ectzo�,xea�t�ixe� (��0.00)-• [ � . �Cn�pj ectoxs' co�eJxfs; (ns�iecEoxs' igxtaiure azo fnxtials) Pate asioectoxs' coMRIMU: , Cinspectoxs'Si�naiuxe- �o?�ii�aTs) ]ate )XuPV,CTTON---,9ERWCV,: yafied-- �,�ectoxs' eopnu7.ep�fs: MOM xnspectzo; (Gts�ecfoxs'Ognatuxe-ioW&78) ' f �7'�7'�CTTOI�T'-• OTR��3e Date e� �- [' � �'az�er� � � �- ' TLe �nsp ecttoxt xe�uired ($�D.O D) •- [ � eetoze coxam.eAts: . �u;s� eefoxs' zgnaiure 3�o xnifiais) Date ' DM TA P -q AP'F TO'R W'eff T,'RD OTTT A ail �f, i tt 7' d�Y�i,�T`7f i` i�+"�'d3Fi .A i� Fi �'I'� 3 + u�3' +C�` +�3 NOT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pylicant Information Please Print Le2ibll Name (Business/Organization/Individual): Address: XV -).4-B,& %fG.TAI/ t, CfqCity/State/Zip: r���/GNU' IJ04 �I Phe e #: 1r 7,�, ��U AreVlam an employer? Check the appr r 1. a employer with /he employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3,\ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Hate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. $ These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 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. I 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 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 Name: Policy # or Self -ins. Lic. #: 0 Y I' L G G r � 9 Expiration Date: 7-,)3 Job Site Address: %d �S V City/State/Zip: r I&o 104 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p s and 0o�ry that the information provided above is true and correct. Si�natt�re� ��� Tlata• Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other IL 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 a 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 Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Date. :500 NORTH TOWN OF NORTH ANDOVER o41 PERMIT FOR PLUMBING SSACHUS� ies that �,This certife /. , , , , , , , , , has permission to perform �,ah h. . E . �" / =� plumbing in the buildings of .. .^-� .................... at ... ��..7?t.s' f..5:........ North Andover, N Nass. Fee. 91-... Lic. No.1.y%.Z ..�...� ..rlo,4. PLUMBING INSPECT Check # /QP-V5—Off V5— /Z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYMA DATE __ . — PERMIT # — — — — — — JOBSITEADDRESS�� — — WNER'S NAME __ — - POWNER ADDRESS -_ -- -_ - ___-- TEL AX TYPE OR OCCUPANCY TYPE COMMERCIAL Ll EDUCATIONAL ® RESIDENTIAL' PRINT CLEARLY NEW: 0 RENOVATION; 0 REPLACEMENT: PLANS SUBMITTED; YES [IJ NO)a FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 1 8 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/O]USAND SYSTEME-71_ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN __-_- --. -- •-__--_--_-__-_ -- -_-- __.-- ---.__-_= _.! FOOD DISPOSER FLOORIAREADRAIN INTERCEPTOR INTERIOR _-- •--.____ -_:.__i _,__; .._- ._-. KITCHEN SINK LAVATORYROOF O DRAINSHOWER STALL _.-,.... SERVICE ! MOP SINK TOILET URINAL f WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER I..- ------------- --------- - --.-...._ INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YEIP NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW �`' LIABILITY INSURANCE POLICY - OTHER TYPE OF INDEMNITY [ BOND OWNER'S INSURANCE WAIVER: am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT [Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in oompliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. PLUMBER'S NAME I- .. -. _ _ LICENSE # SIGNATURE MPS JP[J CORPORATION[I# PARTNERSHIP # LLC�#f COMPANY NAME __- ADDRESS �, Q ' -- CITY ��_^ 1.. --- STATE ZIP TEL [- FAX op _-.-------------------1 .MAIL i IxV /Z Location 1069f l ` � L -5/— No. %No. G S Date Check # 3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �� S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `7 c ✓lt- ,i Building Inspector TOWN OF NORTHANDOVER BUILDING DEPARTMENT \PPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY{ DWELLING Z' < x ->e .1..'X.; w ,..:..� _. ., ;... _ n .... %V`JrtF `r Artµ .. '�" » ._,. >' ,. ., l .a 1:1i 3 `. . _i'..•.� 3UILDING PERMIT NUMBER: Com-- DATE ISSUED: SIGNATURE: !v` C of RuildiriQs Date 5r1q-11UA 1 -alit. Lt'1rvvLLVK ,LXv1, 1.2 Assessors Map and Parcel Number: 1.1 Property Address: lMap J+ G✓P � Number Parcel Number _.A/0, 1.3 Zoning Information: 1.4 Property Dimensions: tonin District use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Rear Yard Front Yard Side Yard Required Provide red Provided R red Provided r 1.5. Flood Zone Information: 1.7 Water Supply M.CxLC.40. 54) • Zone outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 ?ublic 0 Private 0 SECTION 2 - PRQPERTY OV�NERS11MAUTHORMD AGF -NT 2.1 Owner of Record + /C, jj Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature ,z1wrrrtlN 3 - c oNSTRUCTION SERVICES 3.1 Licensed Construction Supervisor- Licensed upervisor Licensed Construction Supervisor: • Address ,Q Signature Telephone 3.2 Registered Home Improvement Contractor Company Name Z /o Address G G�LIIij Kc �Co —CSD Signature _ Tele h e Not Applicable 0 License Number Expiration Date Not Applicable 0 /25-1/ 6 Registration Number ©3/) f/vr;L- Expiration hate y SECTION 4 - WORKERS COMPENSATION (Ni G.L. C 152 § 25c(6) ` Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildme oermit Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check all applicable). New Construction 0 ExistingBuilding 0 Repair(s) ❑ Alterations(s) . 0 Addition ❑ r Accessory Bldg. ❑ Demolition 0 Oth 0 Specify ` N ' a Brief Description of Proposed Work: Jho i� oC) --o ve a. r SECTION 6 - ESTIMATED CONSTRUCTION COSTS Signature of Owner SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION property -- Hereby declare that the statements and information on the and belief Print Date ,as Owner/Authorized Agent of subject application are true.and accurate, to the best of my knowledge G Signaturelof OTvner/Agent r' / Date / / NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDABERS 1 sr 2 No 3 RD SPAN DR\dENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Item Estimated Cost (Dollar) to be Completed by permit applicant 1. Building (a) Building Pernut Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee x (b) 4 Mechanical HVAC 5 Fire Protection 1+2+3+4+5 O Check NumberON 7a OWNER AUTHO TI N TO BE COMPLETED WHEN r6Total RS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on C My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION property -- Hereby declare that the statements and information on the and belief Print Date ,as Owner/Authorized Agent of subject application are true.and accurate, to the best of my knowledge G Signaturelof OTvner/Agent r' / Date / / NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDABERS 1 sr 2 No 3 RD SPAN DR\dENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING x MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Location: lol,)e— J� city Phone F-1 am a homeowner performing all work myself. F -1I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Citv: I V 0, R -o <� Phone #: ��ZJ �CVL4�L� c)(68 ,A—) Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature CC / �� Date 1Gf % G Print name Phone # Check l use only do not write in this area to be completed by city or town official' ❑ Building Dept if immediate response is required Building Dept E]Licensing Board l ❑ Selectman's Office Contact person: —e �/ Phone #: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Date: '� �� Z�u Address: RE: �w Sln�hl�� Yo�� Dear L�Q� Bay State Roofing Inc. proposes to fiuuish all material, labor and equipment necessary to perform the following scope of work roof penetrations drip edge along the roof perimeter. 2 Anew ZS Y cin QC fug asphalt roof shingle will be installed over the A substrate. A new Cobra ridge vent will be installed to ensure the proper roof ventilation. All roof penetrations and flashing will be installers according to the manufacturers recommended specifications and details. SBay State Roofing Inc. will properly dispose of all roof debris in our own waste containers. Total price for this work: S 23 00 OT' g nla wt e a ona 0 per sq, f I hope this proposal is acceptable. If you should have any questions or comments please contact me at your earliest convenience. Respectfully, Sean M. Mahoney, President Rav CYatn Rnnfina Tnn e C/) m m m 0 m COI) 110 CD Cp O ar dS. nco O o p CL Q CCD O a: C:) _• O t0 CD CO) 'C CD a O 7 _m CO ov] Q) C7 CD C2 �F CD CD y CD CA V J 2 O� 0 cn O -Go O Q y =_ dOSo .O CA O �m S!09 m Cl) Z y O a= _� N .O.' m y=r CL T d O CDo m os C y y N Ohm: mCD CA = co O o 0 C2 ;e � O _y A . W .O m =r 7a 6 CL aco_ :\ V m c r CD cL o m ' CLCD p C. O1 y N O. Q O W C. � � d y �' C� Co y -- m CD rA 0 . m d iA CD A O O WrVC o CD CD 0 PF y : d a. o W 0 1 ;Q CD CD cn O d cn o ro y '�j wCL 0 O�v G� � b HM � �7cn'JU C!i n n Ix w ' o G OQ O `v w n ',d G 'r1 G r. C7 M O Cn o 71 O x e O 0 y 0 0 c 3 3 ty y�y p _ •2R Q'7 � � � s 'O ►�• w 1'x'7 y = r. a ,co t� o � o • �+ c, n .� yam', ♦ �•• �1 f o r�.. N o 0 'W � i