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Miscellaneous - 1312 SALEM STREET 4/30/2018
1312 SALEM STREET 210/106.A-0160-0000.0 Ll B mall n1al U mG FILE Date.....//7 . ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ss�o CHU 14 JL This certifies that ................... has permission to perform ......... ........ ................................ L........................... wiring in the building of...................0..40 vt 4V .......................................................... at SF"! .E..g.f..... S .... . ,North Andover,Mass. ic.No. ...(3&I,.q--rA 9.......... �Check o 47 ELECTRICAL61 2S` 39 Commonwealth of Massachusetts Official Use Only ff Department of Fire Services PermitNo._ - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CM 12.00 (PLEAME PRINT rNMK OR TYPE ALL INFORMAT10A9 Date: a — City or Town of: NORTH ANDOVER 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) a/z� Se le44 S,;;,i,, Owner or Tenant ln��f!�,C�d� Telephone No.&TS",7— 9F- 11V Owner's Address Is this permit in conjunction with a building permit? Yes P No ❑ (Check Appropriate Box) i Purpose of Building r`C�SI �s1�,2 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: t4.1,71�4e 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 No.of Luminaires Swimming Pool Above ❑ In- o.o Emergency 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number TonsKW No.of Self-Contained Totals: "" "'" '""'" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local[:] Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* 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 Eci uivalent " THER: Attach additional detail if desired,or as required by the Inspector of Wires. imated 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. The undersigned certifies that such cove5g6 is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ND ❑ OTHER ❑ (Specify:) I"certify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: .k/ /4"n LIC.NO.:1,3$ Licensee: G�u�� yr�L Signature LTC.NO.:11 OLAe(Ifapplicable nt r�" xem t"in the license number line.) Bus.Tel.No.:?ZSf�-00-7-6 Address: X17 Care 49 &6,,p,4 ceel r-Gfl' &Ary /l, 038' 3 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61, ecurity work requires Departmerg 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. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-withthe provisions of M.G.L.c. 143,§3L,the q l 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 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 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 M Failed 0 Re-Inspection Required($.) ❑ Inspectors Co ments: C9 t I-;- Inspectors Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.) ❑ Inspectors Comments: M Inspectors Signature: Date: FINAL INSPE ION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ? ?•' --/'J� DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com t y The Commonwealth ofMassachusetts - Department of ludustriglAcciclents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers, Compensation Insurance Affidavit:Buffders/Cont°actors/Electrxezans/Plu'inber.,q APlease PrntLe pplicant lnfornaatzon �ibly Name(Businessiorganization&divvidual): 4 Allo toG r/��,7�,/G/5g.4 i Address: /T*� 141,-6-41.4 .7 ' City/State/Zip:G •�� � � Q��hone#: �� ✓3�-- 3�g� 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 contraction ployees(fall and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and'haveno employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. 9. Building addition [No workers' comp.insurance 5. ❑We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised.their 3.El am a homeowner doing all work right of exemption per MGL 11.[I Plumbing repairs or additions myself.[No workers' comp. c.152,§1(4),and we have no 12.❑Roofrepairs insuraucerequired.j i employees.[No workers' 13.❑Other comp.insurance required.] "Uny 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 2're dging allwork and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must affached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and joh site information. Insurance Company Name% Policy#or Self ins.Lic.#: ExpirationDate: Job Site Address:, 5a &.+-t S t`' City/State/Zip:/V ,-fn Pdy'e✓' 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 ofMGL o.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 fInvestigations of the DIA.for insurance coverage verification. X do hereby cert! under the p ' and peva 's o f perju eat the information provided above is true and correct. - Signature: Date: Phone#: official use oply. Do not write in 61s area,to be completed by city or tort 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#: f 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 ofhire,- express or implied,oral or w.ritten." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or anytwo or more of the foregoing engaged in a joint enterprise,and includin the legal representatives o e g g p f a d ceased emplayex,or the redeiver or trdstea of as 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 employes." • I MGL chapter 152,§25C(6)also states that"every state or local ticeasing 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 produce d.acceptable evidence of compliance with the insurance coverage requ- ed." 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 fa the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if k necessary,supply sub-contractor(s)name(s),address(es)andphonenumber(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,axe not required to carry workers'compensation insurance. If an LL C or LLP does have employees,apolicyis required. Be advised thatthis' affidavit maybe submittedto the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. he affidavit should f be returned to the city or town that the application for theperm%t or lz'cense is being requested,no E 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 andprinted t p p d legibly. The Department has provided a space at the bottom of the affidavit foryou 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 thatmust submit multiple tipIe ermit/lcense applications ations'man y given earneed on lYsubmit one a£xvindzc indicating currentdait E I policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamp ed or marked by the city or town may be pxovided to the applicant as proof that a valid affidavit-ii 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 (i,e,a dog license or permit to burn leaves eta.)said person.is NOT required to complete this affidavit. The Office of Investigation.-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 an:d fax number: The Commonwca t t o1'Mo.ssa.,rhv Ptfs - Dopattaejat 4£Zudu al Accidonta ofce ofTl]vestiga.-XQitla 600 Wasbingtw keel BostoiiMA02111 dei,0 61M ' ,4Q0 at 406 Qx - MA _ Revised 5-26-05 FaY, 617-727-7749 wtvw.mawagov/(Ra Date. .. ... ... . NORTIy M- o= TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION ��SSACHUSE� This certifies that . . . . . . . . . . . . . . . . has permission for gas mllation . . . . . . . . . . . . . . . . d in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .1�� - G�- .!j?. .4 .�North Andover.,iMass. Feese.&P Lic. No..Fi.6`'. . . / . GASINSPECTO- Check#Oe9 0 7 `} 8233 t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Atr- , Mass. Date City,Town Permit# ` Building N�me'_1 [ �r,�► AT: Location l �1 Type of Occupancy: New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ N cc W a N 1 OZ N W < m H W I-Occ W 0010- azo mhd Zcc o xbd O tu 2 O WW sW <O O > W ar N t7 W W J < W O > I- t, V J h W m t W h 0 t W O N Z p Z < W O W o<e i o e� � eL � 3 o e� J rJ s > O e d h sue-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 6TH FLOOR Check One: Certificate (Print or Type) Installing Company Name To=send W1 f n Tnr ® Corp. Address 27 Cherry Street ❑ Partnership 1lanver5, MA 01921 ❑ Firm/Company Business Telephone 978-777-0701 Name of Licensed Plumber or Gasfitter —.los I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my med under Permit issued for this application will be in compliance with all pertinent knowledge and that all plumbing work and installations perfor provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. operations coverage. includin completed I have informed the owner or his agent that I do not have liability insurance '-�B P Pe Signature of Owner/Agent I have a current*bflityAnsurV policy to include completed oper ns coverage. ❑ B ` U�� y TYPE LICENSE: Signat a Licensed Title ❑ Plumber Plumber or Gasfitter City/Town ® Gasfitter C1APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number Date.. 0/' ................................ koRTH TOWN OF NORTH ANDOVER 0 f- PERMIT FOR WIRING 4K CHU This certifies that ....................................... .......... . ......... has permission to ........... wiringin the building of...... .......... .................... ....................................... at ................. ..................... ,North Andover,Mass. ......... Lic.N674 �?r F..I'. ELECTRICAL INSPECTOR Check #46� 666 )Oici�ll I C )111\ Commonwealth of Massachusetts Permit-In't No. Department of Fire Services Y, 5 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 9 051' I lca)c 1*ink) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK '� \11 %Nork to he rcrtmnied in accol-tialic'!%%Ith the\1:lssadll-lSettS Code(VE ). 527(AIR 12.00 II'LLISE PRLMA, /NK OR TYPEALL LN-FORILITION) Date: City or Town of: AfV joqe le— To Ilse 13Y this ;Ippl icatioll the undersigned gives notice ot,11 is or her intention to Perform the Qlectrlc,ll Durk described below. Location (Street& Number) VI-1 Owner or Tenant lyCl I Z No. Owner's Address Is this permit in conjunction with a building permit? Yes (Check Appropriate Box) Purpose of Building S -se, &--52)/t./ eizf Ltility Authorization No. Existing Service -" Amps Volts Overhead ❑ Undgrd No. of Meters New Service Amps Volts Overhead❑ UndgrdF-1 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: s� sow /Z L/ ( 1/1( "i loll iI"!)loble Incl, /le )I oll'.dhi;/,lie I;Ispu'""r ol It',. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)FansZ/ No.of Total Transformers KVA No.of Luminaire Outlets I? No.of Hot'rubs Generators KVA No.of Lillminaires Swimming Pool above ❑ In No.of Emergency Lighting urnd- I Battery Uoits No.of Receptacle Outlets No.of Oil Burners M FIRE ALAR [No. of Zones No.of Switches No.of Gas Burners No.of Detection and Total Initiating Devices No.of Ranges No.of Air Cond. Tons :No.of Alerting Devices No.of Waste Disposers Heat Pump N mb er ITons IKW I No.of Self-Contained totals: Detection/alerting Devicv&_ No.of Dishwashers Space/Area Heating KW Local F1 Connection Municipal Ii Ii ippl Other 'Security Systems:* No.of Dryers Heating Appliances KW s ems: No.of Walter No.0 No.of No.of 6evices or Equivalent Heaters KW signs Ballasts Data Wiring: No.of Devices or Equivalent A No. Hydromassage Bathtubs No.I)(Motors Total HP I clecommunications Wiring: of Devices or EquiN alert OTHER: Ifluo'l F.,Itiinated Value of lectrical Work: Ok lien required by municipal polic...') kk o rk to �ta rt: II1,13cctions to be requested In accurdafte't�ithNIEC Rule 10, and upon completion. INSLRANCE COVERAGE: (- nlcss waived by the o)rncr. lio permit for(lie perlornimicc orclecti-icill ,pork Ina) issue 1.1111c', the licensee pl-(,�Ides proororliability lll,-alrlllce Includillu, 4)perttion-covel-a,lc of.its "I.11'slIalitial s c.1libitud proof rc the rul-Illit Ill:( K 0\E: R,\X 0."C has ] mill old 11is mpliclit;W (Vid r 1)2.ph-,Ie. 8a l)--- t" 0.3 a3d 6 Address: Alt. T�-I. N .... Security Sy,,itm Contractor Uu.:rvsc nquircd for this l,,(;rk; if itpplicablc.cher Lht: IiCObC 111.1101%1-llt IV OWNER'S INSURANCE kVkIVER: I ;ini ;iwirc that flit: 17th/lave the ll.abllity ill!A11-:111CO ' I"JUired � iawfay 11) :;iUlliltl-IrL bclol,r, I IICJ-Ll-y tthis. I-CCILI'l-01kilt- 1 ;1111 [Ile(check one)0 .)�1mx 11 0 by �*�,.IILI* Owller'Aaent PFR-WIT f-VF7-Q�� C9 5 O f i 6!t r� U 3 Date... .: °.:. .. 4, NORTH TOWN OF NORTH ANDOVER o x PERMIT FOR WIRING I�. ,SSACMU This certifies that : py..... ....................... .. .. 1 ... ... o rfhas permission torm ... *1.1.10 -w < 1............. wiring in the building of ...... _ ................... . ,North Andover,Mass. "Fee./,3.,::::�...... Lic.No�z'�.%t ... �_ ��ELECTRICALINSPECCO t�heck # / !/3U� I I Commonwealth of Massachusetts Official Use Only Permit No. �3 Department of Fire Services ?JF l Occupancy and Fee Checked 'e 5 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INT FO N) Date: o��G{/ 2 z)s City or Town of: �l► dyrh ��u.,� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention tolperfiorm the electrical work described below. Location (Street& Number) Owner or TenantT p Telephone No. Owner's Address Is this permit in conjugction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building � ����;� /�4y�.J���� Utility Authorization No. Existing Service Amps 2Z,/ 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: Completion.othe following table inay be waivedby the Ins ector o Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No_of.Li htin Fixtures AboveIn No.ot Emergency Lightin atte- its No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.o Zones No. of Switches No.of Gas Burners No.of Detection and Initiating Devicest No. of Ranges No.of Air Cond. l No. of Alerting Dev' es ons No. of Waste Dispo rs Heat Pump Numberns KW No.of Self-Conta' ed Totals: Detection/Alerti Devices No. of Dishwashers Space/Area Heating KW Local F1CCo cipal E] Other o nection No. of Dryers Heating Appliances KW Security Sy ems: No.of evices or Equivalent No.of Water KW No. of No. of Data Wi ng: Heaters Signs Ballasts No.of Devices or Equivalent i No. Hydromassage Bathtubs No. of Motors i Total HP Telecommunications Wiring: /Z No.of Devices or Equivalent OTHER: Attach additional detail ijdesired,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 [BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: /- OS Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ,L- LIC. NO.: Licensee: 44t'Z �/,117� Signature LIC. NO:: 3/2 (If applicable, er 1"exer t"in the license number line.) . Bus.Tel. No. eo5' Address: �/, Sl!'� �i/�-�.B��t/ i'21 Z� Alt.Tel. No.: OWNER'S PI ISURANCE WAIVER:TI am aware t at the Licensee does not lave 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 or Signature Telephone No. PERMIT FEE: $ =`� Generators Residential& c) each additional meter ..$10.00 Commercial:. Sewer Ejection-Pump: $25.00-..--� ECTRICAL . ELPERMIT FEES a) including photovoltaic& Signs: $25.00 each ballast (Effective March 12, 2003) generating Equip Per KVA $1.00 Smoke & Heat Detectors MINIMUM PER1viIT FEES;: b) un-interruptible power systems, Initiating Devices: RESIDENTIAL,$;25'0:0 per KVA$1.00 Residential: $1.00 each C.. .. RCIAL $50 00 c) batteries over 100 amp. hours, per Commercial: $60.0 up to 10 Q SI CABLE ON sycell $1.00 devices over 10 - 1.00 each OUTS.I.DE O.F .BUILDING eat Devices: $1.00 each Space Heater/. Air Conditioners: $40.00 each He\t Pumps: $40.00 each area heatinA 1.00 each Alarm Systems Security: (for fire Hyd -Massage Bathtubs/Hot Sub-Pan/pi- S9.5 00 systems see smoke/heat detectors) Tubs:M20.00 each Swiing Pools: Residential: $40.00 Li htin ixtures $1.00 each idential: Commercial: up to 10 Devices Lighting utlets: $1.00 each Above Ground: $25.00 $60.00 additional devices over 10- Major App 'ances: (not listed) Inground: $50.00 $1.00 each $20 each Commercial Pool: $100.00 Carnival Equipment: $50.00 each Motors: (per hor fractional part Switches: $1.00 each CeilingFans: $1.00 each thereof) $2.00 Temporary Service: Commercial New Construction or Oil/Gas Burners Must have Utility Authorization Ntimber Residential $20.0 each Residential $25.00 Alterations: Commercial $100.00 $100.00 per 1,000 Sq. Ft. of Commercial$20.00 a Construction Space Office Furnishings: r circuit $10 Transformers: Commercial Service Change/ (Relocatable Partit' ns/ ubicles) a) capacitors, Per KVA $1.00 Repair: Outlets & Fixt e: $1.0 each b) ducts, conduit& conductors IN-lust have Utility Authorization Number Ovens Built I /Counterp Units: (Associated w/Padmount Transformers) $25 $100 (first 100 amperes or fraction,one $10.00 eac c) each manhole$10.00 meter) Panel C nge/Circuit Brea r: d) each handhold $5.00 a) each additional 100 amperes Reside tial: $20.00 e)per KVA$1.00 capacity or fraction. $30.00 Co ercial: $25.00 fl primary feeders, $25.00 each(over b each additional meter$25.00 600 volts,non-utility owned) P ne Jacks: See g)vaults and equip. $25.00 each Commercial Temporary Service: to/telecommunications Washers: $15.00 each $100.00 Ran es $15.00 each 117ust have Utilitv Authorization Number Receptacle Outlets: $1.00 each Waste Disposals: $5.00 each Commercial Repair and/or Water Heaters: $30.00 each Recessed Fixtures: $1.00 each Maintenance Permit: (Blanket Re-inspection Fee: $25.00 Permit)up to 2 Electricians $150.0 'For "Multi-F a[��il�: per pair of Electricians over 2 $5 .00 Repair to Service Residential: Data/TelecommunicatYach $20.00 j.;t gE� Commercial Project Residential New Construction see drill Ills ector fo ' Residential: $1.00 per (Dwelling): $220.00 �' Commercial: $30.00 upric:I a: devices over 10-$1.00 (With service up to 200 amps) dust have Utility Authorization Number Pahl IC lnedy (978) 623-83106 Dishwashers & Dials: for services over 200 amps see below (Office furs S ani to ;1.0 all-0 $5.00 Each _ a) for each 100 amps capacity or - - _ Dryers: $15.00 ch fraction add$20.00 h.In:Spectio . Schedule: Emergency Li sting(Battery Units) b) each-additional meter$10.00 $ 1.00 each itl >�OI_,€G14 c) each additional panel/sub panel Feeders oeub-feeders: $25.00 1. FINAL each 10 amp capacity of fraction Residential Additions/Alterations: I TR N C II (iapplicable) thereo Resential: $5.00 each $220.00 maximum Co mercial: $15.00 each Residential Service Change or ADDITIONAL Underground Service: Gas/Oil Burners: INSPECTIONS *,4,25.00 (i:I' Residential: $20.00 each $40.00Must have UtilitvAuthorization Number applicable) Commercial$20.00 each I a) one meter, up to 100 amp capacity $40.00 (revised 07/05) b) each additional 100 amp capacity nr fractinn V.0.00 Commonwealth of Massachusetts y O Official.Use Only Department of Fire Services Permit No. ' C Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [R 1 l/99] [Rev. leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TjON) Date: G{/ 2tiU t Cit or Town of: d.e� Y crp� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention t perform the electrical work described below. Location (Street& Number) Owner or Tenant ® Telephone No. Owner's Address Is this permit in conjunction with a building P 1 g permit? Yes ❑ No © (Check Appropriate Box) Purpose of Building.1(� ��.i'GG� Utility Authorization No. Existing Service Amps 22el//,) Volts Overhead Q 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: Conipletionof thefol table may be waived by the Inspector of Wires. No. of Recessed Fixtures No.of Ceil:-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No- Above In o.o mergency Lighting'Swimming Pool n. (� .. :_... _ ,d: . Batter-Units. No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. o Zones No. of Switches No. of Gas Burners No.of Detection and Initiatin Device No.of Ranges No.of Air Cond. ons l No.of Alerting Dev' es No. of Waste Dispo rs Heat Pump Number ns KW No. of Self-Conta' ed Totals: Detection/Alerti Devices No. of Dishwashers Space/Area Heating KW Local ❑ Murcip it ❑ Other Co nection No. of Dryers Heating Appliances KW Security Sy ems: No.of evices or E uivalent No. of Water No. of No. of KW Data Wi n Heaters No.of Devices or Equivalent Signs Ballasts No. Hydromassage Bathtubs No.of Motors f Total HP / Telecommunications Wiring: 1 Z No.of Devices or Equivalent I OTHER: 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: INSURANCEBOND ❑ OTHER ❑ (Specify:) I G�z7 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start://,- 9 Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 certify, under thepains and penalties of perjury,that the information on this application is true and complete. i FIRM NAME: ZLIC. NO.: Licensee: t -'Z� d/� f Signature LIC. NO.: 1 Z (ff applicable, er "ewe t"in the license number line.) . Bus.Tel. No.r�7,� Address: r 4247L, Alt.Tel. No.: OWNERS I'iYSURANCE NY AIV ER: I am awarett at�ensee does not the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)[I owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. eq �rs�,)�� LY 44 Commercial Street Raynham,MA 02767 Tel: (508)880-0233 Fax: (508)880-7232 May 16, 2011 V ED AY 23 2011 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Attention: Health Agent Reference: FAST' Wastewater Treatment System- Serial Number: 25855 Attached please find the Field Inspection& Service Report with field test results for services performed on 5-13-11 at the property of Michael Cronan located at 1312 Salem Street,North Andover, MA. ' '- I I Please call if you have any questions or require additional information. Sincerely, Wastewater Treatment Services, Inc. Service Department Enclosures Copy to: Michael Cronan Massachusetts DEP I � I Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and OW Form for Title 5 I/A Treatment and Disposal Systems 14625 A. Installation Michael Cronan Owner 1312 Salem Street Facility Street Address North Andover 01845 City Zip Mailing address of owner, if different: 1312 Salem Street Street Address/PO Box: North Andover MA 02845 City State Zip 857-498-1274 Telephone Number B. Authorized Service Provider Wastewater Treatment Services Inc. 0&M Firm 44 Commercial Street Street Address Raynham MA 02767 City State Zip 508-880-0233 Telephone Number David Zavelle 12920 Certified Operator Name Certification Number C. Facility/System Information 25855 Bio-Microbics, Inc. MicroFAST.5 DEP ID Manufacturer ID Model Number 12/13/2005 12/13/2005 Installation Date Start of Operation Approval Type: []General [] Provisional [] Piloting [x] Remedial Seasonal Residence—used less than 6 mo./year: []Yes [x] No D. O Operating Information p 9 5-13-11 Inspection Date Previous Inspection Date 14" Pumping Recommended []Yes [x] No Sludge Depth(to be checked yearly) I i 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 Ll DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 14625 E. Field Testing Field Inspection: Color: (] gray [] brown [x]clear []turbid [] Other(specify): i Odor: [] musty [x] earthy [] moldy [] offensive []turbid Effluent Solids: [x] no []some pH 7 SU DO 5.75 mq/L Turbidity NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: [] Influent [] Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 440 gpd Parameters sampled: Influent. [] pH [] BOD [] CBOD []TSS []TKN [] Nitrate [] Nitrite [] Phosphorus [] Spec. Cond. []Ammonia []Alkalinity (] Oil Grease []VOC [] Fecal Coliform Effluent: [] pH [] BOD [] CBOD []TSS []TKN [] Nitrate [] Nitrite [] Phosphorus [] Spec. Cond. []Ammonia []Alkalinity [] Oil Grease []VOC [] Fecal Coliform G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Cleaned Filter, Checked Splash Recycle Notes and Comments: I i 2 x ' Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems 14625 H. Certification 1 certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. C. r t ^e =✓ 5-13-11 Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31 th of each year for the previous 12 months General Use— by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 i 3 .EEND'N axr �. a i n @ UK P.0 R T E O. 8450 Cole Parkway, Shawnee, KS 66227, Phone 913-422-0707, Fax 913-422-0808 e-mail:onsite _biomicrobics.com, www.biomicrobics.com, 800-753-FAST(3278) FIELD INSPECTION & SERVICE REPORT For Bio-Microbics Single Home FAST'System 14625 ME i e ��w{�+} cFt ��2r xn � all ray AUTIORIZED SERVdGE PROVIDERr k�, y i,tia q z r 14 Installation Address: 1312 Salem Street Name:Wastewater Treatment Services,Inc. North Andover,MA 01845 Owner Name:Michael Cronan Mail Address: 1312 Salem Street Mail Address: 44 Commercial Street North Andover,MA 02845 Raynham,MA 02767 Phone:857-498-1274 Fax: e-mail: Phone:(508)880-0233 Fax:(508)880-7232 e-mail: .a;g ..rr '�' - �Lk ^niy.... s_. a-a iJlk; 7+ow':`i ,:�.. i .1, -�L�L' . _' NFORMATION' ", j # .,;J'"n 9 ad a , I- �(-- :..Ie!�»,�'F r�x�;4;.i;?} .x�i-, ".p.:'�h->�'q.c,+~,.�- -nra,si�-...-..�,.,r-:�xa: - �«'� !,. _ - Model No. Serial No. Date of Installation Date of last pump out MicroFAST.5 225855 12/13/2005 8/1/2008 E � n hkimiFrvdr - QPat +{•L ,rr. K 3 r - �- u—N-iANG R'" EN : ,+" ficO�R-2MEDDrTx ANTD P aJ � 7s�kt�ir •f COMMENTS -': Electrical Panel(s) Visual Alarm Operating x Audio Alarm Operating x (if present) Blower(s) Air Inlet Filter Clean x Blower Hood Vents Clear x Excessive Noise x Excessive Vibration x Treatment unit(s) Unusual Odor x Pumpout Required x Primary Settling Zone 14" Aerobic Treatment Zone 12" Estimated Daily Flow 440 gpd pH(Standard Units) 7 Color Clear Temperature 62 Odor Earthy Comments vt4iix MrTEC�HNICItAN SERUICEEDATE ' ,uir SVS:.�..- OMNI A David Zavelle 15-13-11