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HomeMy WebLinkAboutMiscellaneous - 1348 SALEM STREET 4/30/2018 1348 SALEM STREET 210/106.A-0163-0000.0 / / J i Date......t:7 f.T.': 2r.... { f NORTH 1 3�0•t TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ssACHUS� This certifies that ....... has permission to perform ......... ............................................................ ..... wiring in the building of........ ` ' at....� .�4�c ... .......:Sim....................... orth AndovJ!�rs. Fee...-6:Yr- Lic.No...l.®b���........ .. .EL CTRICAL INSPEIt� Check # 10585 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§,3L,the d permit application form to provide notice of installation of wiring shall be uniform throughoutthe 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.01c. 166,§32,an electrical permit shall be issued to the person,fum 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. 0 Permits shall_be limited as to the time of ongoing constructiokactivity,and maybe.deemed_by_the.7nsp.ector_of-Wires abandoned-and.imalid.ifhe_.. or she leas determined that the authorized work has not commenced c;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 ofthe Acts of2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote jobi'growth and long-term economic recovery and the Permit Extension.Act furthers this purpose by establishing an automatic four-year extension to certaispermits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically dxtends,for four years beyond its otherwise applicable expiration date,any permit or approval that was m effect or existence during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. KRU le 8—Permit✓Date Closed: -�.� ** 1a1ote:Reapply for new perwi� ❑Permit Extension Aet—Permit/Date Closed: , \ C OMMOnur.&o�M.M./ .11b Official Use Only rt �r� c7 Permit No. 1 ApartmentO/.tire-Services- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank 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 IN INK OR TYPE LL INFORMATION) Date:hlC'?-/,,3L City or Town of: N Pnoovfr 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) 1-3l.f Owner or Tenant'.\\j� ��nn n,�, Telephone No. — (r�`�—���3 C Owner's Address fj Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building l 61&±IY-e 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 i_ 1 Location and Nature of Proposed Electrical Work: Completion oftheJo2lowing tab a may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA 4' ` No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires '! Swimming Pool Above ❑ In- El o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and -3 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kms, Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent ti 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 undersigned certifies that such coy rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Z BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: I LIC.NO.: Licensee: f- ' Lj rn ra Signature T,71� LIC.NO.: (Ifapplicable ente "exempt"in th license num er line.) Bus.Tel.No.:�f 7sf—��ACb-7 Address: y �i55�Tlo Drarrsf is 01$026 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department 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 ❑owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents - - - ---Office-of-Investigations- 600 —Office-of Investigations- 600 Washington Street Boston,MM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e,gr 1 G/1 �Ti PL/1 Address: y -i55efi7r SQA City/State/Zip: i ,A 01?26 Phone#: q7F Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.Er I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.[ lectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions s myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: f 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains=enalliesofpehat the information provided above is true and correct. 112 Signature: Date: Phone#: 7�` ?W-/Od 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 139 lop i 40'- I 1 I I i, 1 150.00 1 f i r Lo-r 2 481) ZIG S.F.± N to '1 EXIST. I�wEI..LIAJG LOT, Top Or P0UWQF-L=)51.0(p Low- I 1500 Cance. 1 �;E.PTIc TouK 1 �4 l..E.�cH1r.JC, TeEI-IcI-+ �>. (TYPIcAL) y, P Z a' x, D CO E.G.S. B v�L^• (F n.vS.8. 2�3 C. I ELEVATIONS .Ile"I description design as • built INV. PIPE OUT OF HSE. 140.42 no pipe �� AS � B 1 u' I LT INV. PIPE INTO TANK 140.22 no pipe J INV. PIPE UT OF K 139-97 143.38 OINV. PIPE INTO DISTNBBOX 139. 93 140.24 SUB - SURFACE DISPOSAL INV. PI PE OUT OF DIST.BOX 139.76 140 .I 1 INV. END OF PIPE 1 139 .50 139 .62 SYSTEM " n 2 11 139- 55 p 3 II 139.60 " 4 11 139.49 North Andover MA 5 j It 139.55 " It6 139.49 FOR B a R CONSTRUCTION CO . " Sca le: I11 = 40' Date: JAN. 7 , 1 9 8 5 RICHARD F. KAMINSKI AND ASSOCIATES , INC . ENGINEERS • ARCHITECT • SURVEYORS • LAND PLANNERS NORTH ANDOVER , MASS , Board of Health North An4_Ve_rZMaaa. SEPTIC SISTEK INSTAMATICK CNBC$ LIST LOT'S LIVED DATE DISAPPROVED AVAT-IN OK RYdL eaRpnst Nl�JS FAIL Ox 1. Distance To; c, a. Wetlands b. Drains c.. Well 2. Water Line Location 3. No PVC Pipe 4. Septic Tank a. Tees -_Length & To Clean Out Covers b. Cement Pipe .to Tank - On Both Sides of Tank 5. Distribution Box a. Covers.& Box - No Cracks b. All Lines Flowing Equal Amounts C. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped 'Eads d. Clean Double Washed Stone 7. Leach Pits a. Dimensions ._ b. Stone Depth c. Splash Pads d. Tees e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Anal Grading Inspection 10. Barricading Covered System - 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations e. Water Table Board +f gealth JQf-I�vSCw *torch:; adover,Mas a SUBSOHFACE DISPOSAL DESIGN CHECK LIST LOT # DU5 S APPROVED DATE to-2^ DI'SAPPROPED DATE Provided: Reasons: Title V FAIL 09 Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot #j'abutters b location and log deep observation hoes-distance to ties --location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any Bret areas within-100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location arty drainage easements within 1001 of sewage disposal .__system or disclaimer-Planning Board files (3) known sources of water supply within 2001 of sewage disposal a system or disclaimer (k) location of aunt. proposed well to serve lot-1001 from leaching facilit; (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p no PVC to be used in construction (q) profile of system-elevations'of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) maximum ground water elevation in area sewage disposal .system (s) plan must be prepared by a Professional Engineer or other professional authorized, by law to prepare such plans Reg 6 Septic Tanks (a) capacities-1507, or flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground suimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes ------___-_. _eater than 0,08 ---._ Reg 10.4 b) sump M�A►ce D im Check List Pae 2 "FAIL OK _----- -- Leaching Pits ------ . Leaching pits are preferred Where the installation is possible teg lad a) calculations of leaching`area-minirm. 500 sq ft 1 .4 b) spacing. . 11 .10 c) surface drainage 2% 11.11 d) cover material e) 24x21Ar splash pad f) tee at. elbow g) no beads in pipe from d-box 'to,,Pipe Leaching Fields leg 15.1 a) no greater than 20,' autes/ftbh b area-minimm 900 sq ft 15.4 c construction of field 15.8 d) surface' drainage .2 % 3.7 e) 201 from cellar wall or ingrounOvimning pool LeachingTrenches leg 14.1 a) calculaons or leaching area-min 500 sq ft 14.3 kb) spacing-4 ft min 6 ft with reserve between 14.4 c) dimensions 14.6 d) construction 14.7 e) stone 14 10 _ __.. f}--_arfAa9 drainage 2% Downhill Slope a) sopa-y/x = be shown) b) y/x X 150 = (to be shown) EMS Reg 9.1 �a) approval 9.6 b) stand-by power -' 1 1 IS0.00 40' W Lo-r 2 9 48, ?-1(4 S.F.± ' EXIST. I?vvELLIUG it Top of Fouuv.EL'151.00 LOT 3 LoT I ` ISOO Cant. �>EPrlc TouK- .1 'a Le.ncu11.1G TeEWCH Z7' ql (Typic&L) LP oa `/V w 2lCO E.c cb.B l� PP �L �' E.C.S.8. 2�3 V ELEVATIONS description design os built INV. PIPE OUT OF ISE. 140.42 no pipe " AS - BUILT ' " INV. PIPE INTO TANK 140 .22 no pipe INV. PIPE OUT OF TANK 139.97 143.38 SUB � � SURFACE � RC�� � D IS �']OSA INV. PIPE INTO DIST. BOX 139. 93 140.24 J J INV. PIPE OUT OF OIST.BOX 139.76 140 .11 SYST � INV. END OF PIPE : 1 139.50 139 .62 __ N n 2 e 139. 55 IN a r a 139 .60 " a a �� 139.49 North Andover , MA . " a ° 5 u 139.55 FOR : g R CONSTRUCTION CO . 6 11 139.49 Scale:-1 40' Date: JAN.7 , 1985 RICHARD F. KAMINSKI AND ASSOCIATES , INC . ENGINEERS • ARCHITECT • SURVEYORS • LAND PLANNERS NORTH ANDOVER , MASS . TO. NORTH ANDOVER, MASS. January 7, 19 85 BOARD OF HEALTH FROM: DESIGN ENGINEER RE: Soil Absorption Sewage Disposal System This is to certify that I have reviewed the construction materials of said disposal system at Lot 2 Salem Street Site Location Massachusetts. The grades and construction materials are in general eonfonnance to my plans and specifications dated October 1, 1984 and AS-Built January 7, 1985. Registerineer <' Xr PLACE ; CIVIL _ Na.31012 JAL V�4Via' -' I 1go.o0• I W Lo-r 2 481) 21Co A W s EXIST, L?WF-LLIWG Toa OF FouuD.EL?I51.00 LOT 3 L O-T- I 1500 CzoL. �EPrIC T&WIC .1 r LEOCu11.JG TeeNcl-a Z>" (TYPICAL) OQ "All �C ti LP E.C.S.5. Zq 3 C ELEVATIONS description design as - built i) INV. PIPE OUT OF HSE. 140.42 no pipe A S U U I LT INV. PIPE INTO TANK 140.22 no pipe V INV. PIPE UT OF TAK 139.97 143.38 E*A INV. PIPE ONTO DISTNBOX 139. 93 140.24 SUB Sy RFMC E DISPOSAL INV. PIPE OUT OF DIST. BOX 139.76 140 .I 1 ft INV. END OF PIPE 1 139..50 139 .62 SYSTEM p a 2 w 139- 55 I " 3 P 139 .60 " 4 11 139.49 North Andover . MA . 5 139. 9 6 139.449 FOR : B a R CONSTRUCTION CO . " " Scale: I" = 40' Date: JAN.7 , 1985 RICHARD F. KAMINSKI AND ASSOCIATES , INC . ENGINEERS • ARCI•IITECT - SURVEYORS • LAND PLANNERS NORTH ANDOVER , MASS .