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Home My WebLink AboutMiscellaneous - 134 MABLIN AVENUE 4/30/2018 .--l ablin Ave, 134 _ �� /� map 006 Parcel 005 � � _• / I 4' 9750 D- 2 7- �o Date...�............................ NORTF, °�t"`° :•�"p TOWN OF NORTH ANDOVER No. 's PERMIT FOR WIRING ,ss^CHUSE� This certifies that ...........................................................` — z has permission to perform 7 � .. wiring in the building of C ! �1SI ..... ,North Andover,Mass. Fee...�- .~Lic.No. pELECTRIcAL INSP Check # ( ��-S 1 C'ommonwea&o f MaMackwettj Official Use Only c� cc77 Permit No. 7 3!� 2epartrrient o/:tire services :Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 ALLnORMA_TIO� Date: 8 vt2 City or Town oh a � �S 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) 13� 1 '�� 9 8' Owner or Tenant �2�� Cfl:. p s \ Telephone No. Owner's Address Is this permit in conjunctionwithauilding permit? Yes M, No ❑ (Check Appropriate Bog) Purpose of Building (�� Utility Authorization No. � rJ SO. Existing_Service Amps / Volts Overhead❑ Undgrd No.of Meters 7� (2-0 0 It Overhead Und rd No.of Meters New Service Q Amps /2 Volts � g ❑ Number of Feeders and Ampacity : JJ Location and Nature of Proposed Electrical Work: Completion o the ollowin table ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:SusP•'(Paddle)FTr o ota Fans Transformers KVA No.of Luminaire.Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 n- ❑ o.o mergency ng rnd., grnd.. Batt=Units No..of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.'o , eteand Initiatink.Devices Tota No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number Tons No.o _ e Contame Totals: Detection/Alertin Devices No.of Dishwashers . S ace/Area.Heatin KW Local❑ un,cipa ❑ Other P g Connection No.of Dryers Heating Appliances KW Seeur ty y evices* I'Y No.of Devices or E uivalent No.of Water o.o No.o Data Wiring: Heaters IOW Signs Bzllasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications NDevices . firing: No:of Devices or Equivalent OTHER: Attach additional detail.if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: I�7 (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 cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [ BOND ❑ OTHER ❑ (Specify:) I certify, under theains and penalties of perjury, at the information on this application is true and complete. FIRM NAME: e i o& 3 r✓1 e e s LIC.NO.: 15y y(o Licensee: 60rdonyTDCXU,bO Signature LIC.NO.:E aigf 0 (If applicable,enter " empt"in the license number lin Bus.Tel.No.:.978' Address: 3 J ,O 25 laf) 1,4 D/9f3 Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work re es Department of Pub 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 Elowner's a ent. Owner/Agent PERMIT FEE: $ S Signature Telephone No. } r Date.. 751 46RTH Of I TOWN OF NORTH ANDOVER . � PERMIT FOR GAS INSTALLATION . o �9SSACHUSE4 This certifies that . .w . . C1Aa. . . . . ��?4 h . . . . . has permission for gas installation in the buildings of . .lf` ' ��!h. ) . . . . . . . . . . . . . . . . . . at . . At'.611 n. . ./7/l/ . ., North Andover, Mass. Fe�.�D 0. . Lic. No./.3.(0.!Y. . Ae -/. . . . GASINSPECTOR Check#�— ' f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: A)O ��y"`G2— MA. Date: Permit# Building Location: ` 11/-h AUC Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [ New:A Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES ui ca Z m m L) _ a 0 0 x N iii D z 0 LU LU v U) ~ w O E w W o z Z ° a L W o a Ir- Lu U) w m 0 Q a I- a w X Q LL > w w m LLJ w U) x w w z W N -J Q a m w 0 z O N > z I x O a a LL Q a w w >O a W H > > > F- 0 o w u. (7 (7 x x SUB BSMT. J, BASEMENT 1 FLOOR N 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8TH FLOOR f / Check One Only Certificate# 1 � G l/� �J Installing Company Name: l (-/ � y7 ❑ �1 Corporation Address:��f� i co Y �-0C)! City/Town: ML%(!�'yt'/ State: X ❑Partnership Business Tel: Fax: Eg Firm/Company Name of Licensed Plumber/Gas Fitter: s` INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes P No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ® Other type of 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 Owner's Agent By checking this boxes;I 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. Type of License: By ❑Plumber Title El Gas Fitter Signatu o Licensed lumber/Gas Fitter ®Master City/Town []Journeyman License Number: 3411 S 4/ APPROVED OFFICE USE ONLY ❑ LP Installer 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 hire, express or implied,oral or written." An employer is defined 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 or trustee of an 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 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 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-contractor(s)name(s),address(es)and phone number(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,are not required to cant'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 confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should k 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 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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications inany 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations 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 and fax number: The Commonwealth of Massachusetts Department of Industrial accidents Office of Investigations 600 Washington Street - Boston,MA 02111 Tel.#617-7274900 ext 406 or 1-877-MA.SSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia 9 7 5 5 Date......../17... + TOWN OF NORTH ANDOVER PERMIT FOR WIRING S. ,SSACkUSEt This certifies that ......... ..... ............................................ has permission to perform ........... ......................... wiring in the building of........... ........................................... at.......113..q.....f .. Aq ......North Andover,Mass. Fee... Lic.No... ...... ELECTRICALINSPECTOR�� / Check # cornmontveaA of Ma.3eachaeetb Official Use Only J. cc�� cc77 C� Permit No. 42L/ a Department o�, ire Jerviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONSRev. 1/07 � ] (leave blank) APPLICATION 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 1NINK OR TYPE ALLjORMATIO Date: :" ►10 City or Town of: . �� To the Inspector of Wires By this application the undersigned gives notice of his or her intention to erform the electrical work described below. Location(Street&Number) �3 � � Y� y ri ": '-' 99� Owner or Tenant �2�� o;,.,.r� p S Telephone No. Owner's Address Is this permit in conjunction ewilding permit? Yes with a No ❑ (Check Appropriate Box) Purpose ofBuilding . `�+ Utility Authorization No. 9 "l Vt Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps UP /9.10 Volts Overhead Undgrd❑ No.of Meters Number of Feeders and Ampacity : 5}b. V�. �[e. -� 7z�o A Location and Nature of Proposed Electrical Work: Com letion o the ollowin table ma be waived b the lns,ector o Wires. No.of Recessed Luminaires No.of CeilAus . addle o.o Total P -Taddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA bove. n- o.o mergency g ing No.of Luminaires Swimming Pool rnd. ❑ - . ❑ Bgae=Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches. No.of Gas Burners o.o . etection and J Initiatin .Devices a No.of Ranges N%of Air Cond. Total Tons No.of Alerting Devices Heat Pump Number Tons No.o fSe Contained No.of Waste Disposers ........_....................._......... p. Totals: Detection/Alertin Devices Municipal No.of Dishwashers . Space/Area.Heating KW Local❑ Connection ❑ Other ® No.of D ers Heating Appliances KW . Security. yysterns:* IY No.of Devices or Equivalent No.of Water No.of c:o Data Wiring: o° Heaters KW Signs Ballasts No.of Devices or Equivalent Total HP Telecommunications irm No.Hydromassage Bathtubs No.of Motors o 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: (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 J, „ undersigned certifies that such cov rage is in force,and has exhibited proof of same to the permit issuing office. C CHECK ONE: INSURANCE BOND OTHER ❑ (Specify:) Y ❑ I certify, under the ains andpenalties ofperjury, at the information on this application is true and complete. FIRM NAME: e )Ca 3e r✓I e e S LIC.NO.: 45y y(o Licensee: Sol-016 t) JLroovW00d Signature LIC.NO,: 01/Q f c (If applicable, enter " empt"in the license number lin �\ Bus.Tel.No.:.978=d y8-1S5 7. P Address: 31 La a.s an NSA 61213 Alt.Tel.No.: lc ,. *Per M.G.L. c. 147,s. 57-61,security workreyaires Department of Pub Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re wired b law. B m signature below,I hereby waive this requirement. I am the(check one ❑ owner ❑owner's agent. I � Y Y Y L� Y Owner/Agent PERMIT FEE: $ 55� Signature Telephone No. ,/� ��. 6 �ti