HomeMy WebLinkAboutMiscellaneous - 13 WALKER ROAD 4/30/2018 (6)S�A�J
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TOWN OF NORTH ANDOVER
Office of the Building Department
Community Development and Services
1600 Osgood Street
North Andover, Massachusetts 01845
RE: 13 Walker Road
North Andover MA 01845
Telephone (978) 688-9545
FAX (978) 688-9542
September 17, 2014
At the recent visit to 13 Walker Road Unit 6 several Building and Electrical
Violations were observed.
This Building is a commercial Multi -family and falls under the 2009 International
Building Code, 780 CMR
Section 105.1 Required. Any owner or authorized agent who intends to construct,
enlarge, alter, repair, move, demolish or change the occupancy of a building or
structure, or to erect, install, enlarge, alter, repair, remove, convert or replace any
electrical, gas, mechanical, or plumbing system, the installation of which is
regulated by this code, or to cause any such work to be done, shall first make.
application to the building official and obtain the required permit.
Thank you for your attention to this matter. If you have any questions, please call
the office of the Building Department at 978-688-9545.
Sincerely Yours,
Brian Leathe
Building Inspector
Date .... .. . /,F-, � .........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..........
. .............................................................................................................
has permission to perform ........
,6
wiring in the building of ........... D. i. rw ..........................................................................}hf.....
............. g�n ... a. North Andover, Mass.
at ...... ....... ..
Fee Lic. No;?-ZU4(o . ...............................
e ........... ............ . .. ... ELECTRICAL INSPECTOR ---
Check #
5�
Y .
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
'M
.#
Official Use Only j
Permit No. t 0 l 5-1
Occupancy and Fee Checked
:ev.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: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives n�icg of "r her intention*pe form the electrical work described below.
Location (Street & Number)
Owner or Tenant (—I
L!�
Owner's Address
Is this permit in conjunction with a building per it? Yes ❑
Purpose of Building s%/ °,/� C -,-t, a G _
Telephone No.
No ❑ (Check Appropriate Box)
Utility Authorization No.
- Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
14
Q,
No. of Recessed Luminaires
No. of Ceil.-Susp. (Padde) Fans v
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above ❑ In-
Swimming Pool ❑
rnd. rnd.
o. of Lig ting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No, of Zones
No. of Detection and
No. of Switches
No. of Gas Burners
Initiating Devices
No. of Ranges
No. of Air Cond. Tons Tot
No. of Alerting Devices
Heat Pump
Number
Tons
No. of Self -Contained
No. of Waste Dis osers
P
Totals:
J.KW _
............
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P g
Local ❑ Municipal ❑ Other
Connection
No. of Dryers Dr
Y
Heating Appliances Kir
Security Systems:Y
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of wires.
Estimated Value of Electrical Work: � lorl/ (When required by municipal policy.)
Work to Start: ( � Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE VE G : 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 ofperjury, that the information on this application is true and complete.
FIRM NAME: A LIC. NO.:
Licensee: 5 2 �,. � SS7S Signatu LTC. NO.: e- 6
(If applicable, qhter " )in c n mtm r line.) • Bus. Tel. No.: �.
Address: Alt. Tel. No.:
*Per M.G.L C.'147, s. 57-61, security work require epartment 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 ❑ wner's agent.
Owner/Agent MIT FPP� FEE: $ 0
Signature Telephone No.
❑ 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 4
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 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 effector 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 M
Failed 0
Re -Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
u
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH ECTION:
Pass.
Failed
Re- Inspection Required ($.) ❑ r
Inspectors Comments:
f
Inspectors Signature: &-
Date: — 2- ^ /
FINAL INSPECTON:
Pass EN
Failed ❑'
Re- Inspection Required ($.) ❑
Inspectors Comments:
..s
Inspectors SnatT��tn
Date:
U
DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com
.114
J•
The Commonwealth of :Massachuseus -
_ Departmentoflnciustrigl,4ccicients
Office oflnvesiigations
600 Washington. Street
Boston, .MA 02111
www.massgov/ciia
Wo rkexs' Compensation Imurance Affidavit: EuUders/Cont°actoxslElectricianslPXiimbers
Ap>,licanti �nforrnation Please Print Lee bly
Name(Businessiorganizaiionffndividual):6O
n
Address:
Phone
6r�ry�5
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, F1 New c6nstruction
employees (full and/or pare time)
2. I am a sole proprietor or partner-
have nodthe sub -contractors
listed on the attached sheet.
7, F] Remodeling
. ship and`haveno employees
These sub -contractors have
8. E] Demolition
working forme in any capacity.
workers' comp. insurance,
5, ❑ We are a corporation and its
9. D Building addition
[No workers' comp. insurance
officers have exercised.their
10.❑ Electrical repairs or additions
required.]
3.E1 I am. a homeowner doing all work
right of exemption per MGL
11 • Q Plumbing repairs or additions
myself. [Foworkers' comp.
c.152, §1(4), and we have no
12,QRoofrepairs
insurancere ed. �
employees. (No workers'
13.❑ Other
comp. insurance required.]
xAny applicant that checks box#1 must also fill out the section bel6w showingtheir Workers' compensation policy information.
f 'Homeowners who submitihis affidavit indicatingthey ae doing all worK and then hire outside contractors must submit a new affidavit indicating such,
lContractors that check this boar must attached an additional sheet showingthe name of the sub -contractors and their workers' comp. policy information.
I am an employer' that is providing Workers' compensation insurance foY fny employees Be o is the policy tartd ob ,site
information.
Insurance Company
Policy # or Self, itis. Lie. M Expiration Date:
Yob Site Address: City/State/Zip:
Attach, a copy of the workers' compensation-polley declaration page (showing the policy number and expiration date).
Failure to secure coverage as regy6dundex Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a
Blue 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 tine
of up to $250.00 a clay 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 here ert� under tr parous and pe hies ofperfury triat the ire• formation provideed above is true�aand correct,
C'ivnafiira , n 4' 1 j�l't Ad.L, 4, Date: 2/ z
Official use only. Do not Write in iNs area, to be completed by city or town official.
City or Town: PermitJLicense 0
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. C41Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other -
ContactPerson- Phone
• �w
Information and Instx°uctians
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuaa t to this statute, an employee is defined as "...every person in the service of another under any contract oXhire,-
express orimplied, oral Or•writien."
An employes is defined as "an individual, partnership., association, corporation ox other legal eniaiy, or any two or more
of the f`oxegoing 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 notmore 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 ofpublic work until acceptable evidence of compliance with, the insurance
requirements of this chapter have bPon presented to. the contracting authority."
Applicants
Please till 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 certificates) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members orpartners, are notrequired to carry workers' compensation insurance. If an LL C or LLP does have
employees, a policy is. required. Beadvised that tbisaffidavit may besubmitted tothe 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 andpriated legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event to Office Of Investigations has to contact you regarding the applicant.
Please be -sure, to til1 in the permit/license number which will be used as a reference number. In addition, an applicant
thatmust submitmultiple permit/licemo applications is 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 M copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the
applicant as proof that a valid affidavit -ii on fide for future permits or licenses. Anew affidavit must be filed out each
year. Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture
(i.e. a dog license orpermit to burn leaves eta.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and shpuld you have any guestions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The CQmo Wealth of Massachu Ptfs
Depat(me,u,t Qf fadwtdal Accidents
OBice of1AVesifga#Q)Rs
6,90 WaM gtm S re t
BQAQI� .021X1
TQ1. 0 617-7-27-49-00 ext 406 or 1~877•,11ASqAF8
Revised 5-26-05 Fax # 617-727-7749
WWW- agQvId'a
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