HomeMy WebLinkAboutMiscellaneous - 124 BERRY STREET 4/30/2018 I \
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ORTN,�O
TOWN OF NORTH ANDOVER
- PERMIT FOR WIRING
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This certifies that ...........................................................................................
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has,permission to perform .............................�.1,...... ..............................................
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wiring in the building of.. .. .................................................................. .........
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:N rth Andover,Mass.at ...... , .... - .............
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ELECTRICAL INSPECTOR.
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Commonwealth of Massachusetts �ase only
- Department of Fire Services Permit No.
Occupancy and Fee Checked
aM BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 CMR 120
(PLEASE PRINT ININK OR TYPE ALL INFORMATIOA9 Date: 7 /w D o/'y
City or Town of: NORTH ANDOVER To the Inspector oil-Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) - i l�R,
Owner or Tenant G C Rf-,y .5..r L,L c Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
4 Purpose of Building 1' t n rr.%Ly Utility Authorization No. 1 9 7 9 ,9
a,? k
Existing Service__),J 0 Amps /1L1 0 Volts Overhead❑ Undgrd[9""" No.of Meters I
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ft'7 r L ptce M>: t C-k S o c k e-Y 2 it l.6 cA4 E `
(i1fvF auT �� r��w+�P/�c�r -r-�-��i 1 ��N ��°►yl �
Completion of thefollowi g 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 ❑ In- Elo.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
TotInitiatin Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices o
1` No.of Waste Dis posers Heat Pump N__umber Tons I.KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other
1 1' g Connection
r No.of Dryers Heating Appliances KW SecuritNo.o
Systems:*
or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
1 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value oflectrical Work: 0,2 o O d (When required by municipal policy.)
Work to Start: 7 115— Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C ERAGE: 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 cove Le is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [0" BOND ❑ OTHER ❑ (Specify:)
I certify, tinder the pains and penalties of penury,that the information on this application is true and complete.
FIRM NAME: . ��f PP e-f �o iv LIC.NO.: A/3 r)J-C
Licensee: J d(` ���,�j�•ref Signature LIC.NO.: G L%73
(If applicable enter "exempt"in the license number line.) / / Bus.Tel.No.-y—, �T
e3�
Address: J5- -Lh-JcAS rt a ti IZ �e/� � �/ , � Alt.
*Per M.G.L c. 147,s.57-61,security work req ires Department of Public Safety"S''License: Lic.No.
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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. $
❑ 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 �q r
notification of completion of the work as required in M.G.L.c.143,§3L.
Permits shallbelimited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires 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 Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 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 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 ❑
❑Permit Extension Act—Permit/Date Closed:
Trench Inspection
Pass F?1 Failed '❑ Re-Inspection Required($.) ❑ ]?
Inspectors Comments:
Inspectors Signature: Date:
SERVICE PECTION:
Pass Failed 0 Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date: Z -1
PARTIAL ROUGH INSPECTION:
Pass Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
r
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass M Failed Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
FINAL INSPECTION:
Pass M Failed Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
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The Commonwealth of Massachusetts
z Department of Industrial Accidents
M _ I Congress Street,Suite 100
Boston,MA 02114-2017
yqr www mass.gov/dia
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workers Compensation Insurance Affidavit:Builders/Contxactors/Edectxicians/I'lum ers.
TO BE FILED WITH THE PERMTTING AUTHORITY. Please Print Legibly
A ' licant Information
NamO(Business/Organization/Individual):
Address-
City/State/Zip: Phone#:
y eck thea pP p 'Type of project(required):
Are you an emp to e .rChro riate box:
em to ees full and/orpart-time). 7. ❑N&'donstruction
If]I cam a employer with p y
2. I am a sole proprietor or partnership and have no employees working for me in 8. Fj Remodeling
any capacity.[No workers'comp.insurance required.] 9, ❑Demolition
3.E:11 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition
4.❑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
11.0 Electrical repav:s or additions
proprietors with no employees. 12T[]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•.[]Rb6f repairs
These sub-contractors have employees and have workers'comp.insurance.t 14.r]Other
6.[]We are a corporation and its,officers have exercised their right of exemption per MGL c.
152,§1(4),and ive 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
tContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not(hose entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer til at is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Nance:
Expiration Date:
Policy#or Self-ins.LIG.#:.
City/State/zip-
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL e.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 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 Iuvestigations of the DIA.for insurance
coverage verification.
X do hereby cert' under thepa' s�a:n�dpenaltles ofpef jury that the information provided ahoy is true correct✓J Date: 1
Si ature:
Phone#:
' G l7- bd (a 3
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
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#•
Contact Person'
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 Wo,
express or implied,oral or written."
An employer is'd'etnied 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'dr trustee of au 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 requuiired."
Additionally,MGL chapter 152,§25C(1)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=contractors)name(s),address(es)and phone number(s)along with their certificates)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 conipauies shodld 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 permittlicense 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 wwwmass.gov/dia
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9 COMMONWEALTH OF MASSSCHUSETTS:.
BOARD Of
E:LE CTR 10 I ANS ; '
ISSUES THL:f OLLOWI NG L I C€NSE AS
R GISTMED MA, ER: ELECTRI. IC A
.1 os. P GIBBONS
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35 LANDCASTER COk#NTY W
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UN.I<;T: �r:A �
HARVARD MA 01451 1143
BUTTERWORTH & O'TOOLE, INC.
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294 FJUL
CaDVED
SALEM,MA 01971-8294 6!I
TEL. (978)741-5731
FAX (978)740-9109 2 42014
claims@butterworthotoolexom TOWN OF NORTH ANDOVER
07/11/2014 HEALTH DEPARTMENT
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
North Andover, MA 01845 North Andover, MA 01845
RE: Insured: Berry Street Investment LLC
Address : 124 Berry Street
North Andover, MA 01845
Policy No . : 1136907
Loss of : 07/08/2014 Wind
File or Claim No. : 44-0737
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws,
Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws,
Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer
and include a reference to the captioned insured, location, policy number, date
of loss and claim or file number.
If no reply is received from your office within ten days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
Patrick Tobin
Adjuster
:t-nor
1r`?
Member of
National Association of Independent Insurance Adjusters
BUTTERWORTH & O'TOOLE, INC.
F p
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731
FAX (978)740-9109
claims@butterworthotoole.com
07/11/2014
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
North Andover, MA 01845 North Andover, MA 01845
RE: Insured: Berry Street Investment LLC
Address : 124 Berry Street
North Andover, MA 01845
Policy No . : 1136907
Loss of: 07/08/2014 Wind
File or Claim No . : 44-0737
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws,
Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws,
Ch. 139, Sec. 313 is appropriate, please direct it to the attention of the writer
and include a reference to the captioned insured, location, policy number, date
of loss and claim or file number.
If no reply is received from your office within ton days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
Patrick Tobin
Adjuster
P
Member of.
National Association of Independent Insurance Adjusters
To: Mike McGuire
Bldg inspector
North Andover
From:
Joanne and Steven Fiore TED
124 Berry Street
North Andover
978-683-4155
Re: Livery service for airport runs
Dear Mike,
We would like to start a livery service for airport runs. We already have a 2004 Cadillac
Escalade(s.u.v. type vehicle)that is currently used for personal use, and this is the vehicle we
would like to use for this business. It is kept at our residence (124 Berry Street,North Andover),
and we would like to keep it at the same location should we start the livery service. We would
not have a store front,just a business phone number.Nor do we intend to use any signage,just
newspaper ads and flyers direct mailed to businesses. Also, we intend to do airport runs and
business runs only, no `nights on the town' or proms at all.
Thank you so much for your consideration, and please call with any questions you may
have.
Joanne Fiore
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NOMTN
•- ::� � �'��; Zoning Bylaw Denial
Town Of North Andover Building Department
400 Osgood St. North Andover, MA. 01846
Phone 975 9645 Fax 9784;U-9542
Street: 07 �/ /I,r
IMa Lot: i U
Applicant: -:7-0o,j,✓e- �. v�� <o f V—
R uest: A/&-e
Date: /"4, o L 7i
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zoning
heat Notes ttem Notes
A Lot Area F Frontage
1 Lot area Insufficient 1 Frontaae Insufficient
2 Lot Area Preexssting 2 Frontage Complies
3 Lot Area Complies 3 Preexisting a `t s
4 Insufficient Information 4 Insufficient Information
B Use 5 No ac om over Frontage
1 Allowed G Contiguous Building Area
2 Not Allowed Z/ S 1 Insufficient Area
3 Use Preexists 2 Com sea
4 Special Permit Required 3 1 PreexLsting CBA `t S
5 Insufficient Information 4 Insufficient Infornation
C Setback H Building Height
1 All setbacks comply 1 Height Exceeds Maximum
2 Front Insufficient 2 Complies
3 Left Side Insufficient 3 Preexisting Height `� S
4 Right Side Insufficient 4 Insufficient Information
5 Rear Insufficient I Building Coverage
6 Preexists setback(s) 1 Coverage exceeds maximum
7 Insufficient Information 2 Coverage Complies
D Watershed 3 Coverage Pn mdsting K r 5
1 Not in Watershed v S 4 Insufficient Information
2 In Watershed j Sign
3 Lot pri2r to 10/24/94 1 Sign not allowed
4 Zone to be Determined 2 Sign Complies
5 Insufficient Information 3 Insufficient Infornation
E Historic District K Parking
1 In District review required 1 More Parking Required
2 Not in district 2 Parking Complies
3 Insufficient Infornation 3 Insufficient Information
4 Pre-existing Parkingr
Re for the above is checked below.
Item e 1 S ial Permits Planning Board Item 0 Variance
Site Plan Review Special Permit Setback Variance
Access other than Frontage Special Permit Parldng Variance
Frontage Exception Lot Speciat Permit Lot Area Variance
Common Driveemy Special Permit Height Variance
Congregate Housing Special Permit Variance for Sion
Continuing Care Retirement Special Permit Special Perniits Zoning Board
independent Elderly Housing Special Permit special Perrrhit Non-g4w4bming Use ZBA
Large Estate Condo Special Permit Earth Removal Special Permit ZBA
Planned Dr4slopmod District Special Permit special Permit Use not Listed but Similar
Planned Residential Special Permit Special Permit for Sign
R-6 Density Special Permit Special Permit preexisting nonconforming
Watershed Special Permit
The above review and atacthed aaplehation of such is tared on the plans and irhformaft Submitted. No definitive review and
or advice shall be beaw on verbal ehplehslitm by the app-ant nor shill such verbal s plerntions by the aPPwwtt serve to
provide dafmkw answers b the above reesorhs for DENIAL. Any inaccurecies,mmhm d V lrhtarrnation,or other subasquerht
coerVes to the infornoft wbn II Myths applicar 1 shell be grounds for this roviaw to be voided at the disrxation or the
Building Dgwtrn@nL The atlacihe'docunmd tited-Mm Review Nw dve shell be dMchod'- i m and incorporated herein
by rshrsrce. The b Mit depm h- g will reWn all piers and dochmenlaton for theabove file.You must file a new building
pemrit application form and begin the p 0 Praoess•
Building Department Official Signature Application Received Application Denied
Denial Sent: If Faxed Phone Number/Date:
' Plan Review Narrative
The following narrative is provided to further explain the reasons for denial for the application/
permit for the property indicated on the reverse side:
3 OZ iL-eN Se 2S .a, fi� %ye
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Referred To:
Fire Health
Police Zoning Board
Conservation Department of Public Works
Planning Historical Commission
Other BUILDING DEPT