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HomeMy WebLinkAboutMiscellaneous - 140 WINTER STREET 4/30/2018DateIV/ ...... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...!L..7....i2� :............1 �'�' .................. �.................................... has permission for gas installation .. in the buildings of ............................. .......................................................................: at .........................*.l nC ��:/1� ", North Andover, Mass. Fee. f.�? ...... Lic. No.....�.�? . P .. :.. /......................:.......:..................... v GASINSPECTOR Check # 3Z� GOWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY T h b ko tue_� _ � MA DATE PERMIT # JOBSITE ADDRESS Q } h OWNER'S NAME I ADDRESS ITE L _ FAX OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL RESIDENTIAL _ NEW: E] RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO Q APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERl BOOSTER— CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR r; 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 5 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES JE] NO Ej IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY © BOND F 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 [tel AGENT E] 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 compl'ance with Pertinent ov' ion of t Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLU;7MGF ASFITTER NAME C �� I % _ LICENSE # _ 014- SIGNATURE MP Ejl JP 0 JGF _j LPGI CORPORATION # = PARTNERSHIP ®#= LLC #r COMPANY NAME: 4n! n. -rh%Rct, IADDRESS / I hd L.5 S CITYL(J )b1 ,IO j STATE En ZIP C� _ TEL FAX CELL EMAIL \0 J Y, , �/1�'t'1 `-� V"I (i� Q -C . ��.�Jv� I 0 P 0 z 0 w a rA w NL � z° ONEl W } rA � W °z H LU a U LU w � � 4 Q w co WW O w w w to a a a a gLn 0 J E., a a � w x w H LL H z 0 H U a a a The Commonwealth oflMlassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Phone #: Are you an employer? Check the appropriate box: L ❑ I a employer with 4. El am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors 2. l am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *.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 ate doing all work and then hire outside contractors must submit anew 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N Policy # or Self -ins. Lie. #: Expiration Date:. Job Site Address: City/State/Zip: 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 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 ofup 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. X do hereby certo under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Offccial 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 Informati®n 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 -contractors) 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 carry 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 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 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in 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 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 permits or licenses. Anew 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.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 Com monwoalth of MassaC&U tt, Department of Industrial Accidents Office ofIuvestigatiions 600 Washington. Streat Boston, MA 02111 Tel, # 617-72.7-4900 ext 406 or 1-$77�,MASS.FB Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia vi ISSUES TNE!ABOVECICENSE TO R' T I BAUL'-T SOLS STREET£ iGTOtJ pr x 'A 11 X67 X5/ 1/14 LAOi -2 ti 0 11 " Date...% -3.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 0'`� .......................................................................................................... has permission to perform, .. ....... wiringin the building of...... �L) ..... . ..................................................................................... -, If �� �J/. . at ................ ................. ........................................ ...... <*orth Andover, Mass. 41, / 'oo Fee .... ... .1.... ............... Lic. No. N ......... q1 ............................. EL' Checkt /6V57 12051 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official/Use Only Permit No. l 2-0 S, Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MECO, 527 CMR 12.00 (PLEASE PRINT IN MK OR TYPE ALL INFORMATION) Dater City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention tP.Perform the electrical work described below. Location (Street & Numbw ! % �,�y Owner or Tenant %&,, v e W, /hi a2 Telephone No. Owner's Address 1116 &Z,1OCU S /-- Is this permit in conjunction with a building pe mit? Yes ❑ No V (Check Appropriate Box) x) �''- Utility Authorization No. Purpose of Building - Existing Service pQ Amps a a / `fie Volts Overhead ® Undgrd ❑ No. of Meters l New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 74& 11 Completion of the following table maybe 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. -OTEmergency ig ting rnd. grnd. 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 Tons No. of Alerting Devices No. of Waste Disposers p HeatPump Totals:........................... Ner Tons ......................... KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 E uivalent THER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /, Od (When required by municipal policy.) Work to Start: `� V-1 C l� 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 cove e is in force, and has exhibited proof of same to the permit issuing office. UR CHECK ONE: INSURANCE ;?= ❑ OTHER ❑ (Specify:) I certify, tinder thepa s andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: ti� C�s�.�f/ �lGr`�C LIC. NO.:� 33 Licensee:j��av6ti.'S ct"I'A'o, Signature LIC. NO.: 3 `� (If applicable, enter " empt" in the ltcens umber line.) Bus. Tel. No.• Address: &r a ' r �� IW, ,� aJ, 4 Alt. Tel. No.: 7&- 70--/ 3 9G *Per M.G.L c.'147, s. 57-61, security work requires Departmerft 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 ❑ o er's agent. Owner/Agent PERMIT FEE: $ S' e n L Telephonjp No. ��ntung�Y�e-i�-F--�-I: Uro .� } ❑ 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 r 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 N Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspecto s Signature: Date: ROUGH SPECTION: w. . Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Sig ture: Date: FINAL INSPECTI Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comm ts: Signature: Date: Inspectors DEB WEINHOLD 0"A TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrigl Accidents 07 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): ��rij,, � ,,v 2 A Address:_ z2, G City/State/Zip: �i�iri r���`/1 Phone #: q"7,? — t_lx 5"S •-6 f,? V Areyouan employer? Check the appropriate box: 1. E I am a employer with 4. ❑ I am a general contractor and I Type of project (required): ' 6. ❑ New construction employees (full and/ part-tim3).* 2. ❑ I am a sole o er- have Hired the sub -contractors listed on the attached sheet. ❑Remodeling proprietor ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its 9. ❑ Building addition [No workers' comp. insurance required.] officers have exercised their 10. Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' 1311Other 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 a -re doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. / /! e /% r d r 0( Policy # or Self -ins. Lic. #: Expiration Date: 'J / �✓ c'G / �j Job Site Address- Z� o v � t� City/State/Zip: Iva 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 c. 152 can lead to the imposition of criminal penalties of 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 cer ' under thepains an enalties ofperjury that the information provided above is true and correct. - Sienature:,!,, Date: l e C Phone #: % 7S 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 Pers Phone 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 -contractors) 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 carry 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 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 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in 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 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 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.e. a dog license or permit to bum 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 Go onw.ealth.ofMassachusetts Department of Industrial Accidents gfftee of Investigations. 600 Washington Street: Boston, SIA 02111 Tel, # 617-727-4900 ext 406 ox 1-877�7MASSAFB Revised 5-26-05 Fay, # 617-727-7749 www.mass.gov/dia f �b DATE: I�- 11 I 117 rte: LOCATION: OWNERS NAME: Da v e- GENERATOR kw 9�-K) //►� NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: ��U✓LU %S dery®ry'��p, G. G PHONE NUMBER: �7� ---� 5`lg -<-'9r6E ELECTRICAL RESIDENTIAL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: k� *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL North Andover MIMAP December 11, 2013 I wx .. s a , s. ,x', c .• � m' %•�. � �{ �` ,' a � � ., � '° s, d,�}�. y sr , y. " �. � r %` ♦+s^} r i, � p ,# �Ir W Ta$ 4 �„w Fdn �e„« a R � k r. ^`: Ar . �: ` ;�' '4 ' �''",,.".�"` dr �:•r xk'b., ads.. K 4" * e *_�. " ,�+ %,!'fit# r+r"•,. <. �4..p j .e� a,,,. ��y�.. Interstates - - -- Interstate - - - Major Roads Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, -- Roads .. Meters Data Sources: The data for this map was produced by Merrimack - NORTM - Valley Planning Commission (MVPC) using data provided by the Town of t Easements Of as ueO deq� North Andover. Additional data provided by the Executive Office of E3 MVPC Boundary ? 9e e 00 Environmental Affairs/MassGIS. The information depicted on this map is O Parcels - 3' G for planning purposes only. It may not be adequate for legal boundary F. -^ 9 definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING - THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY • t ;, OF THESE DATA THE TOWN OF NORTH ANDOVER DOES NOT - - - * o ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF ♦q`" THIS INFORMATION �9SSAtNUS 1" = 291 ft �. North Andover MIMAP December 11, 2013 #858 #880 -..,��� /103:0=00T7 103.0-0084 s#905 1.030=0 it ,/ / 103:0=0081#28 103.0-0 90 ~l ! 11013.0-0036 #870. 3.0-0091 4 103. -Ok 2� 1 T 3/0.-0037 ��%9 103.0 000 #1j 103 b=0038_ #52/ / 103.0-00 103 0 01. _ r MOO,i 103.0-00 9 #865 #39 -'_ ' /// •- ' � 103:0'00 8 103.0-009. ' ' 103:0=0 26'� • • / •�' #15 4 _ ',"�.. . .. #855 •'• .:.. ..'�••' . YO' .0-UU97 1030-0096 •.-_' :103:0-01L7_'. • #59 • ;%• ;1103.0-0107 "- " ��3%095 �• 103.0 00 TO .:0-0094 #795 #801/ :• #95 ... ' 103 0-0108 103.0-0102 • .::.103:0-0099 /� �/ #19 Water Protection Rl / j/� 103 / / / 1.03:0=0031/ Y03:0- 100 � /// #20 " �9140 r � ✓ J #1.3'5 ,� % - �.:. •.. #11'5 � `F # r 1103 0 0030" 103 0 0 Y #41 • • .: / 103.0-0106 #25 1030105 104: --0007 T0,4.0-00 .....::....: _:. • .: 103. ; .2:0 , _-.�. .:'-... ....._ 08 # 1 2j •...: #15 �, - :. 104: 005 ,e_ ,. .. . ... ,..... T04:C-0006•#21 #230 '�• ••�• . 104. -001 .. ,'..�' . a C=(1041 - . .:. • '• � 1'04 _ .. :.. tic - :-.. ..:• .� .:••.: 2 104. --0 i3�'':: :.• ::' _.:'... _...• :__. -... #� - 104:C 0,098 1.04.E-00 6 #182 •104:G_ 16 �"�• t _. 104.E-0097 •104:01 #2 1 #207. --_ -_ 1fl4.C-4011�� f, 0.4: '0099 #96 #196 W� 04�Ej0072 t __ - _ �• '. 'k'`w#2 $ 104.E-0054 #100/ T04.G 0073 _.. _ _ _ - - : ' 10.4:0-00 3 0 :C-0103 —Rail Line =`iu Wetlands Interstates - I= Exempt Lands — Interstate Zoning 0 Busine O Busine - s 1 District s 2 District Horizontal Datum: MA Staleplane Coordinate System, Datum NAD83, —Major Roads Busine M. Busine s 3 District , - - s 4 District NOR?M - - - Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads - C. Easements - - - a GeneraBusiness O Planne RX Comdo District �Of ac 'a� Commercial Dev ? b�++� - '°+s �Q Development Disl North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is ❑ MVPC Boundary Municipal Boundary 0 Corrido O Corrido 3 L Development Dist O. to Development Dist 0- _ - p for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay e Adult Entertainment i'R Indusfri C7 Indo 1 DisMct # .. ♦ 2 District _ �,, f 4 t • ^ >w THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT C3Downtown Overlay District Indus 1% D Industd 3 District - X o -'C 4 - - 1 S District ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Historic District ® Wafer Protection ' �. Reside p Reside ce 1 District - 'j1 qO�+�toF�pt.,`St� - 2 District THIS INFORMATION O Parcels IM R—ide ca ce 3 Distnct SAC NUS 0 Hydrographic FeaturesA 1" = 291 ft de —4 -Ede ca4 Distract ce 5 District - - - - -- Streams P de ce 6 Distract ," a a idential District - - 12/13/2013 01:16 9786585032 PAGE 01/02 ' C & J EQUIPMENT, INC. 1.88 MAIN STREET WILMINGTON, MA 01887 (978)658.2022 FAX 4 (978)658.5032 www.cjequip.com DATE: • FAX#FROM: "A& OYA C� RE: PAGES: c X11 avivr l r--" A,,J u'T � 7n�� Al� vv�+ d 41-,14 ►M A,D40,j e,, (D GENERATOR APPLICATION DATE: LOCATION: �A �ti Cil nWNFRS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL RESIDENTIAL GAS COMMERCIAL LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL TEMPORARY GL IV d�I S Date .......7`..40-e.7 p` TOWN OF NORTH ANDOVER Y PERMIT FOR WIRING 1 This certifies that................,.................................................`............'. has permission to perform' .r!GTf.................. Wi wiring in the building of ..................... L G at...... ........ ... ................... N .........!..! ....o........A...n.d..o..v..e.r..,..M.�as..s.. Fee.....d.. Lic.No...a3.nfl{.. ELECTRICAL INSPECTOR Check # 7531 .41 Mom Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Permit No. Occupancy and Fee Checked Rev. 1/07] (leave blankl 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 ALL INFORMATION) Date: -71 ZOI O 7 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) ( t-( D CO t ,4� %r C Owner or Tenant D AY F— W. L\ %Ar >& S Telephone No. Owner's Address 140 9—L Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building V,1 -i C-Xtr.a 54*k Utility Authorization No. Existing Service Zcx> Amps I Zb / 7—c4cd Volts Overhead Er 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 of the following table may be waived by the lnspector of Wires No. of Recessed Luminaires y!> No. of Ceil.-Susp. (Paddle) Fans o. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires L( Above n- Swimming Pool ❑ ❑ o. o mergency ig mg rnd. rnd. BatterV Units No. of Receptacle Outlets S No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Detection an InitiatingDevices No. of Ranges Totay No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers eat Pump umber ons . K ......... o. o Self -Contained Total 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 Heaters KW o. of o o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent 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: `i 17-C1/0 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COV RACE: 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 E BOND ❑ OTHER ❑ (Specify:) /,.certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.:—t Z3 MfL Licensee: L iky mj lZ;c a Signature , ..+— LIC. NO.: L'i t"'N fZ (lf applicabi entg� ' exempt" in the license number line.) Bus. Tel. No.: bei ' `t Zr. 303 t Address: �O 1doX IZ4, V+4w+1p+ars ;:Ak\S N %A b3Sgy Alt. Tel. No... &PCI - �rr12 bSg7 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: 1 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. $ IS\ 7 7--6 � � G� m Vj Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 o www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letzibly Name (Business/Organization/Individual): Q% c.c- EAe Jv,%c_ Address: 40 o l c1 S+lN4 V, Q� F6 94=K l Z 4 City/State/Zip: jpklu, ,.. Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. X .I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. ❑ required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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: 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. I do hereby cern nc(er tains and penalties of perjury that the information provided above is true and correct. C'icrnar�rra• (}j>� � rl�+o. '-7 �7.a /.c � Phone #: iPb 3 — ?z- <P _ �<=) -Z�, / 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 #: Of,NORT1y 1h 0 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... • .... • . • . • . has .permission to perform 5,7,ftk plumbing in the buildings of P14.W1 ........ PKr 1� 5T h Andover, Mass. at'I... ............ m Fee ' 9O.. Lic. NoA;'-�/9 ............ Pk BING INSPECTOR Check # 7457 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) n NORTH ANDOVER, MASSACHUSETTS _ Date !la', hr) Building Location ��0� \� Owners Name- ���'� Permit # Amount Type of Occupancy New Renovation rl Replacement Plans Submitted Yes No FIXTURES (Print in type) rl�k r Installing Company Name Check one: Certificate Corp. Partner.' Firm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy P� Other type of indemnity 11 Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent 11 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 knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa tate Plurqbing C e and hapter 142 of the General Laws. r By: 31gnaLUM UL LACenSWum r Title Type of Plumbing License City/Town APROVED (OFFICE USE ONLY icense Number Master Journeyman APPR Date. �" . �/- C.. ?...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . ' .G r.r ! , , , l) f t . has permission for gas installation ......�f.:. t ................. in the buildings of ... .. . . ...................... . at ...tl .. .....` ..... North Andover, Mass. Fee...)..... Lic. No....?/.7....-.. l_�`�-7 ......... / GAS INSPE&OR Check # � ) - r/ 392 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING G (Print or Type) Y Mass. Date 01 Permit # Building Location `�� (�/rte/ � f`/ Owner's Name 4411/Gf -F i Type of Occupancy�J'/G1-PjiJ'Ti GC/ New Renovation ❑ Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company ,NameGLIMATE DESIGN Check one: Certificate Address Stewart�Slree `_" Corporation 1 y �� 3 C. Haverhill, MA 01830 =Partnership Business Telephone Lic. Plumber: Michael H. House Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of ,IAGL Ch. 142. Yes ✓ No C If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity G bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Signature of Owner or Owner's Agent Check one: Owner Agent C I hereby certify that all of the details and information I have submitted for entered) in the above 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. r 1, Type of License: By Plumber t - Gasl*tter Tide fda ver Signature of censed Plum be .or Gas Finer Cityrrown --. Inurneyman License Numbe APPROVED 1OFF10E USE ONLY) • .r zCX • Ce Uj• • • • • • • • • • •• • •U Cc >U•ci..• ■■■■■■■■■■■■■■■■■■■■■■■■■ I -H- • • • EE■E■■■■■■■■■■■■■■■■■■■■■ ..• ■■M■■■■■■■■■M■■■MEMO■■■■■ ••NOMINEE■■EO■■■■■■■M■■OM■■M FLOOR ■■■■O■■OM■■MMM■■■MOME■E■ 'Lt ••• ■OE■EEEMOEEOO■■■DEMO■■EOO Installing Company ,NameGLIMATE DESIGN Check one: Certificate Address Stewart�Slree `_" Corporation 1 y �� 3 C. Haverhill, MA 01830 =Partnership Business Telephone Lic. Plumber: Michael H. House Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of ,IAGL Ch. 142. Yes ✓ No C If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity G bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Signature of Owner or Owner's Agent Check one: Owner Agent C I hereby certify that all of the details and information I have submitted for entered) in the above 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 provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. r 1, Type of License: By Plumber t - Gasl*tter Tide fda ver Signature of censed Plum be .or Gas Finer Cityrrown --. Inurneyman License Numbe APPROVED 1OFF10E USE ONLY) e "M rm rm O z FM LA ft ep e "M rm rm O