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Home My WebLink AboutMiscellaneous - 125 JOHNNY CAKE STREET 4/30/2018 (2) r T 125 JOHNNY CAKE STREET 210/107 A-0186-0000.0 Date...4 7 ".� .. O NO oTM ft" ' "� TOWN OF NORTH ANDOVER o � PERMIT FOR WIRING ,SSAtMUSE� This certifies that ............ Jr�...K! .. ....!"!!.1 ..... has permission to perform � 77s-r /...... wiring in the building of......... . ............................................ �- -T�'�� /� 'C .... 0 ,North Andover,Mass. Fee...'{x %..... Lic.No..?'r. r ............... f.! ELECTRICAL INSPECTOR / Y Check # 6 b j i _C_1\ Commonwealth of Massachusetts Official Use Only 92. WYE evi Department of Fire Services Permit No. Occupancy and Fee Checked MY BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M�C),537 CMR 12.00 (PLEASE PRINOR TYPE ALL INFORMATION) Date: (a 001 City o Town f: �� Jazz To the Inspe for o Wires: By this applicatio dersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) j , k1^XaAe_ 5f, Owner or Tenant Q/✓ Telephone No. Owner's Address, Is this permit in conjunction with a building permit? Yes ❑ No x BLDG PERMIT# 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: Install low voltage security system at above location -� Completion of the following 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 Above In- o. o mergency Lighting No. of Luminaires Swimming Pool grind. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS [No. of Zones of No. of Switches No. of Gas Burners No. In Detection and InDetection Devices No.of Ran es No. of Air Cond. Total No. of Alerting Devices g Tons K Heat Pum Number Tons........11�w........... No. of Self-Contained No. of Waste Disposers Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Other No. of Dryers Heating Appliances KW urity Systems:* 1 ,. Y No.of Devices or Equivalent No.of Water No.of No.of in ; Heaters KW Signs Ballasts No.of Device&-oruivalent Bathtubs No. of Motors Total HP Telecommunications Wiring: No. Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: Q (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. The 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 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Brinks Home Security LIC.NO.: Licensee: John Holmes Signature q _ LIC.NO.: 749C (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 978-657-0443 Address: 155 West Street Suite 6 Wilmington,MA 01887 Alt. Tel. No.: *Per M.G.L. c.147,s. 57-61,security work requires Department of Public Safety"S"License LIC. NO.: SSCO 001163 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: $L , Date •.61.i+TLEU)cgs • TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . .�fL(7, , , ,F,e�7-1? has permission to perform . . . . . . . . . . . . . . . . . . . . . wiring in the building of . . . .l.(�ET. . . . . . . . . . . . . . . . . . . at .k t.. .,.. . . . . . . . . . . .North Andover, Mass. 'flee . 5T Lic. No. .1.N 9 4.3. . . . . . . . . ELECTRICAL INSPECTOR Check# S723 1153 i �Q� �►f iu�afft Oft IktOnly BOARD OF FIRE PREMMON REGULATIONS OccupalwT and Fee Chiccloed } APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AUworktQbepw&=Wa+soc memo tCode,st7CMR12" (PLEAZPWffXM0&MEAUW0RMAU0Aq Date-- CRY or Town of 14, A .,TvL&-4 �- 2 �'o the _ By dmf of Lis orLer l Vicat warkdescnInd bdotrr. Imcatioa(set&Number) Owneri�rTeuaut_ /�� G✓��3 Si2��2 Tdopl oue No. Owner's Address Is this Permit in conj=cVoa WIM a buftag penur. Yes _ Purpme of Bulitfmg ® No Q (Cbe**Wropriate,Boz) Uoty Authorization No. Bxist#ng Service Amps ! Vohs iced❑ Undgrd Q Naofine�rs Net-Service -Amps / Yoits Number of Feeders and Amp�acity t""t ❑ No.of Meters Location and Nature of Propcued Elect ical work: fcble bewaf0edby0m ro $'fret No.ofRecessed Luminsimofd }Fans of TOW 5 Na of Luaharre UatletS "A ofEWTubs Generators- RVA NO.of L I?'ool ❑ 0 o. No.of�Qat �0°� Q ofI3rTBursces Na Of7AMes No.ofd '7 Na:of tea BM== ofbefeetkFullind Ne.ofRaages ofAirCosd. Vow Tons ofAle fmg Deter No.of Waste Dispmn Ifeld�. ons No.of DishwashersIlftes gpudArea Heafg XW 0 e� No,of Dryers Heating APP6saces commakinIC w No.o a I .of - Heaters Baltasts- Data � No.H Na of Devices or ivab:nt YdtageBathtubs No:ofims OT R, _ Tota!HP �of Deviees or nen - t Estimated Valuc ofaecalcal Wm1c eltladi a d d' orarrequin d by Ike tarpecrorofff lres bY�alPolicy-) Work to Start: Inspecom to be i�c in 8100uhim to PA C lje Itl,sad upon cmWk im he icensw P ;;UygRAG�: ih>leas V*W by ft oww.w P� P ofeiectdc work may issue mdm fimumm s euvemge is in fenwctdmg acumqfidod w A age or its ual substaequivalent, The wo;and adulfted piafsaiaeto gopent issuing ofee. CHECK ONE: 01SUxANCE fib wM Q cram 0 (Sperm) f CW*A mrder lkepahn andpamrw pfd Brat&evrformolman ibis is teas and c�ompl NAME: 17ktf i 3 i.s`L fa,CSL Licensee: CWT %#�f~i�3L, i:t}s3 LI.NO: i fel b ls. LIC NO. fll��emer pr6/ee�emrarli®-tare) Address; y � si' I1lr1.$ti}',9i+77L'i1t� sem. ; � Bus.TCL No.`I7i"iSqL-b2A,2 *Per bLG.L r~147,s.57-t:1,SewtttY�c p �Pobbc AFL TeL No:: 1S T 3 x'73 jf OWNER'S INSURANCE WAIVER: Iam awme that Ow Salim � LiG Na by la. Bymysigaeknbebw.Iberebgwaive doer the�brb't9 m4 affi the{heck Rue ❑ow= 0 owixes Slguataii t TfthoueRm PER ITI E: r . ., .. , r. r C ' J The Comnwnweadth of Massachusetts Print Form DqwfteW ofIndnYftWAccidv& I Congress Street Suite 100 - Boston,MA 02114-2017 ww».masLgov/din Workers'Compensation bunrance Affidavit:Bwlders/Contractors/Electricians/Plambers Applicant Information Please Print Legibly Name(Business/Organizadan/lndividual): DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST City/StafelZip: NORTH ANDOVER.MA-01845 Phone#: 578-682-6262 Are you as employer.Check the appropriate beat: Type of project(1eguireft 1.0 I am a employer-with 7 4. 0 I am a general comer and I # have hired the - Ors 6- ❑New mon employees(fill aocllor part�rme). 2.[1 I am a sale proprietor or partner- ]Wed on the attached sheet. 7. ❑Remodeling ship and have no employees Thi sub-contractors have g_ ❑Dernolition wortang for me in any opacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp-insu°'ance Z 1equ re&I 5-❑ We are a corporation and its 10.2 Electrical repairs or additions 3.[]I am a homeowner doing an work officers have exercised their I L[]PIumbing repairs or additions myself(No wodme comp, right of exemption per MGL 12.0 Roof repairs insurance r° -J t c.152,§1(4),and we have no employees.[No workers' 13.E]Other camp.insurance required_] 'Any aWicat that checks box g1 must also fiR curt the section Below showing their workers'compensation policy information.-. t Homeowners who submit this affidavit indicating they are doing an work and then hire outside eWbUctos must submit a new affidavit itidicatme sucr- ;COOtr-bots that check this box must attached an additional sheet showing the name of the sub-conttac tm,and state whether or not tbaee entities hate employees. If the sub-oonmwturs have employees,they must provide their workers'comp.policy numhber. i am as employerThabo p"widmg wnrken'canrpansadm mums ce for my anWoyees Below a the paMw and job site information: Insurance Company Name.. THE HARTFORD Policy#or Self-ins-Lit #: 08 WEC C18293 Expiration Date: MARCH 1,2013 Job Site Address: � f J y C.q r� City/State/Zip:_ AbeN 444- O/JVS— 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 on 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 nsuranye coverage verification. Ldo _ of - awthe. . - provided above is true and correct Phone# 578-682-6262 Offidal use eak. W aotwrke is ibis meq to bele aby tray oriorva offidaL City or Town: permi#/License# Authordy(code one): L Board of Health Z g Department 3.Cityffown Clerk 4.Electrical Inspector &Phrmbing Inspector &Other CoataetPerson: Phone#: TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . .r' �l /�. . . H?�R . �'SS . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . a in the buildings of. . .�j 65-�-Ile . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .,1 .,". . C�j?-. u ..`�.�.._. . . . . North An ver, Mass. GASINSPEC Check# �/�r, 7 8363 -Qx MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK UVCITY: MA. DATE: A r g -l a PERMIT# JOBSITEADDRESS: . Tc hey GGTP Sc} OWNER'S NAME: ms' s✓I tvPAMP �- GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:® REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCESZ FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 9c NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY JA 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 ❑ 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 best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: M 9y-k y'5 t'S_s LICENSE# /1 9 y SIGNATURE COMPANY NAME: blti ers e S J A--P Icy� ADDRESS: (y Q�a� f't°" CITY: 'r IX!n 5 S✓•4 cy 0 STATE: S ZIP': FAX: 92f-- I /5-S S 7 0 TEL: 97ff- 6yy- a//0 CELL: 9 /S -7F1G3 EMAIL: es MASTER EZ JOURNEYMAN❑ LP INSTALLER❑ CORPORATION P# d-5 6 PARTNERSHIP❑# LLC # V/W1 l � �� COMMONWEALTH OF MASSACHUSETTS PLUMBER:; AND '.ASFITTERS LICENSED AS i, JOW,,-NEYMAN PLUMBE 'ISSUES THE ABOVE LICENSE TO: MARK W BURGI :�S 6 OLD KENDALL RDS TYNGSBORO MA 01879-1023 22900 0501/14 164645 4 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER f ISSUES THE ABOVE LICENSE TO: Mf PK W BURGESS i v i s 6. ULD KENDALL RD TYNGSBORO MA 01879- 1023 11894 05/01/14 164644 i COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS REGISTERED AS A PLUMBING CORP ISSUES THE ABOVE LICENSE TO: MARK W BURGESS BURGESS PLUMBING & HEATING INUjj8 6 OLD KENDALL RD • i TYNGSBORO MA 01879-1023 2986 05/01/14 164643 ti • The Commonwealth ofMassachusetts Department oflndustrialAccidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.massgovklia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Auulicant Information Please Print Le ibly Name(Business/organizationftdmdual): B U r� -e S.S' h C Address: 6 o%d Ke,,-d 9 // re City/State/Zip: 7 yL-t g S;f a v-o �41 g Phone M - &Y 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. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• [J Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. g• D Building addition [No workers'comp.insurance 5. ® We are a corporation and its officers have exercised their 10.E]Electrical repairs or additions required'] airs o right of exemption per MGL 11.0 Plumbing rep r additions 3.El I am a homeowner doing all work g P myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.] i employees.[No workers' � .1311 other comp.insurance required.] `Any applicant that checks box 41 must also fill outthe section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. yam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. / / Insurance Company Name: CV- r_0 V^ �'\ A� d )Jt'�'/ M ,", Policy#or self-ins.Lie.#: Luc O 6 a b % O A Expiration Date: �"�Y Job Site AddressL c�S . f° " '�' C' GfP City/State/Zip: h 'Ah� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,50 0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby certo under thepains and penalties of perjury that the information provided above is true and correct. Signature• i `�L Date: - Phone#• / g- Y S — a-/ O Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# 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#: Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Mark & Emily Webster Property Address: 125 Johnny Cake Street Policy Number: BDRCWQ Date/Cause of Loss: 2/10/2013, Weight of Ice and/or Snow File or Claim Number: 27793-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 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. Ryan Werner On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Sig7TMENT and Date ANDERSON ADJU CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03063