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HomeMy WebLinkAboutMiscellaneous - 102 PETERS STREET 4/30/2018 (2)lk 'IT � Date ...... Z. —. -i ?� / TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... ..................... . . ......... ............................ ..... has permission to p,,,..T A, A ".7 G2. .. .................. ..................................................... wiringin the buil C— qing of ........ 7 . ....... ...... .......................................... at .................. 7—,;.p . . ................. North Andover; Mass. e e Liorc . No. ... . 7............. ...M... . .......... ILECTRICAL INSPECT m- ....... ChOck# 11428 he Commonwealth of Massachusetts Office Use Only 2 Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK# 3 9 1 0 Occupancy & Fee Checked ( Rev. 11 /99 ) (leave blank) ttiPPLICATION 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 February 27, 2013 --City or Town of North Andover To the Inspector of Wires: By this applicationthe undersigned gives notice of his or her intention to perform a electrical work described below. Location(Street & Number) 102 Peters St G���� �i� (ice Owner or Tenant Dundee Properties BUILDING CONTRACTOR Owner's Address 30 Glenn St CONTRACTORS ADDRESS Lawrence, Ma Is this permit in conjunction with a building permit Yes .a No Building Permit 91 b IP A 67M Purpose of Building Commercial Utility Authorization no. 1 3 7 8 8 4 3 Existing Service 2 0 0 Amps 120/208 Volts single PHASE Overhead B Undgrd xB No. of Meters Three Mast Service Syphone New Service Amps Volts PHASE Overhead e Undgrd e No. of Meters Mast Service Syphone Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Install wiring for commercial office space with 200amp Underground Service, two tenante meters and one house meter. Cmmnletion of the fnllowinn tahle may he waived by the insnentor of wires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Transformers Total KVA No. of Lighting Outlets No. of Hot Tubs Generators Total KVA No. of Lighting Fixtures bveIn- Swimming Pool Above In- gmd F-1 No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FHW FHA FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners FHW FHA No. of Detection and Initiating Devices. No. of Ranges No. of Air Conditioners Total No. of Alerting Devices. Tons No. of Waste Disposers Heat Pump Number I I Tons KW I No. of Self Contained Detection /Alerting Totals: Devices. No. of Dishwashers Space / Area Heating KW Local Municipal Other Connection Connection No. of Dryers KW Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of Signs No. of Data Wiring: Heaters Ballast's No. of Devices or Equivalent No. Hydro Massage Tubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equvalent 'ETHER: 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 E] (Specify:) (Expiration Date) Estimated Value of Electrical Work $ ( When required by municipal policy.) �Z� Work to Start: December 20, 2012 Inspection to be requested in accordance with MEC Rule 10, and up mpletion. certify, under the pains and penalties of perjury, that the information on this application is true and corn I _ FIRM NAME Leonard Electric, Inc. of/� LIC.NO. A10638 Licensee Address Signature LIC.NO. 154 Fletcher Street, Lowell, Ma. 01854 Bus. Tel. No. ( 978 ) 937-8620 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner F� Agent (please check one) Telephone No. PERMIT FEE $ 1 2 5. 0 0 (Signature of Owner or Agent) 3 --1 L?- (3 6-r (� Z 4 9 The Commonwealth ofMassachusetts',�y",1; Department of Industrial Accidents .i Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Leonard Electric, Inc. Address: 154 Fletcher Street Lowell, MA 01854 Phone #: 978 937 8620 Are you an employer? Check the appropriate box: 1.21 I am a employer with 20 4. E]I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ 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 cheeks 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. xContractors 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Phoenix Insurance Co. Policy # or Self -ins. Lic. #: UB2733R731 Expiration Date: 6/30/2013 Job Site Address: fD2- aLl&i� sT Cit /State/Zi /t�, y P�_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and that the information provided above 0 true and correct. 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 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone #: This certifies that ... 2/z /3- %1 C . , , , 44 C ..... has permission to perform .. �7Ztic.�J.c{l .. , , , , , , , , , wiring in the building of , , , at 0 Z.. / ..... �,— ?7: . . , North Andover, Mass. FgeA /.� ?�� L,ic. No...l ?- 3k11gV.......... ELECTRI AL INSPECTOR C'.eck # 306,2? 11162 4 Commonwealth o f ;Vaeeackweth " 2epartmznt of im Semicei V BOARD OF FIRE PREVENTION REGULATIONS a Official Use Only Permit No. l 1 l k - Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of:�.t/�O✓c,� 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 Li J-4 J Telephone No.VR49/B6133 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building o, /CE BL a. Utility Authorization No. /3 788 X39 Existing Service Amps / Volts Overhead ❑ Undgrd� No. of Meters New Service s2:50 Amps /AZ0/,Z1P0Volts Overhead ❑ Undgrd No. of Meters 3 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: !/Y/A°E �WO OFF/C f�S A.VD LA�V�Rt> NAL Completion of theollowin table may be waived by the Inspector of Wires. No. of Recessed Luminaires -1 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 ❑In- ❑ rnd. rnd. o. o Emergency Lighting 6 Battery Units No. of Receptacle Outlets o No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 12 No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total © Tons C� No. of Alertin Devices �a g No. of Waste Disposers 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 3000KW ,2 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 if desired, or as required by the Inspector of Wires. 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. Tlie undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert fy, under the pains and penalties of perjury, that the information on this application is true and complete. FIRMNAME: CKB Electric L.L.C. LIC. NO.: Licensee: Ernest R. Hart Signature LIC. NO.: 14361A (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: (978) 685-0301 Address: P.O. Box 2062, Salem, NH Alt. Tel. No.: (978) 809-2600 *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. $ ri i 1-9 J The Commonwealth of Massachusetts Department of Industrial Accidents ?' y Office of Investigations d 600 Washington Street E Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): CKB Electric LLC Address: P.O. Box 2062 Citv/State/Zip: Salem, NH 03079 Phone #: (978) 685-0301 Are you an employer? Check the appropriate box: Type of project (required): 1. ® I am a employer with 4. ❑ I am a general contractor and I 6. E] 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. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.:9. E] Building addition [No workers' comp. insurance required.] ui ] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions . 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have. no 131-1 Other employees. [No workers' comp. insurance required.l *Any applicant that checks box #I 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company (Policy # or Self -ins. Lic. #: Hanover Insurance Expiration Date: 3/10/13 job Site Address:% City/State/Zip: eV oo, ,0DV491T d� � Attach a copy of the.workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.' Phone #: (978) 809-2600 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Tel: 978-682-4042 February 25, 2013 DUNDEE PROPERTIES, LLC. Since 1971 Town of North Andover Peter Murphy, Electrical Inspector 1600 Osgood Street North Andover, MA 01845 Re: 102 Peters Street, North Andover Dear Sir, Fax: 978-682-3413. Please be advised that, effect immediately, CKB Electrical is no longer the electrical contractor of record for the above captioned project. Leonard Electric, Inc. of Lowell, Massachusetts will be the electrical contractor of record as of February 25, 2013. CKB paid and billed the owner in the amount of $600.00 to cover the electrical permit, and we respectfully request that the permit be transferred over to Leonard Electric, Inc. at no. additional cost. Please contact the project coordinator, Joseph Leone (978-687-7105) if any additional information is needed. Sincerely, Jeffrey D. Sheehy Manager Mailing: Office: P.O. Box 3099 • Andover, MA 0 18 10 30 Glenn Street . Lawrence, MA 01843 I f Ll to $a" rs} � ' �•�:a �,... � !„ 6.' +. �1`3� r s r' t g ire �1a �'�.f i.. m.. .f � �Y �,; y,4� *�`'$ �y,.,�#�rt ° wx ��� ♦f# E�' y.. PLS Y ,e��. � 'M" �'S A.�iY4 $§=t SES *u!'r a7"i, aP +�''�"�° �. k � a+,a`x `� � mss+ .+�. _*� iit"� #.. �, iF � Y e � d ✓+fi � � �fi': ..�,{ '�� ,�... s" xs i�$' Ry. �� mA A t` SYR }� �k��y'��'. ' z � �' f';'�tcGi•Yyj °. �� �a� _�� `t 6' • � , .� i.�y �`� � �,°� €may* ... r o d* . �Y�� �, - i :J€ Y fib' v .r .� �. , � � �' *.' ;Rx •4P p t :.. ,P d �''R � �at ir* _�; 6 'Ap9„'' '.ry 2x' ` "^". y.3 "�,yg } 4'i y kT `i'• #' 4'xv ,bsy`'.i ey e"- 4%' ..y'2��pgrF� + . '' oto rt ' a`w sx �� x rl ��'r � f r � s+ • $• as ^, � �` + ' �x ter- � z�, *$ • , � � �� � ���+' x +,s41 ,o,` .+ar`• w " J' , • c§Y 3 `a a A 0 h Q - c0 m z r r r 9 D m cn Q cn D m O 2 00 m v <;05 N n O h O (C C O . 0.=+3 � 0 m N O O zr =rCD (- CD CD N cD r cn 5 --1 � (n o �. Vm cn Z 3 a.. -,, (D m DO N v0� 0m`� 0�w cn .0 X 0< 0)c m Q 0 v (D 0 a� U) 0 0 rn �m o oCD � -o rn m 5. 0 o n O m rn 0-0 v o 0F� CD aCD _Q 3 CL v 5 (n < n CD =T' o cQ � � o 0 0 o 90 (n = � o 3 0 m m D �' ;u , m m O � -n v N D o .A n IM (r .:f Location 102 - No. 6z,l- IV p2- No.dzl-IV Check # 6,703 27251 Date 112 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee F7,,,J $ TOTAL $ i Building Inspector gi u R. OR O DIE -a .0 rA w 00 o 0 t a 0 cr v $ A. M. EO, Y� a M 63. n s � - u%+ 0 w04 fal mm ro -a .0 rA w 00 o 0 t .a v $ A. M. EO, Y� n s � - u%+ 0 w04 fal mm ro ( = 1-_, u ST o _ �, i