HomeMy WebLinkAboutMiscellaneous - 15 CABOT ROAD 4/30/2018 J 15 CABOT ROAD
210/015.0-0032-0000.0
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_ Date.... ..... ... .......................
F r1ORTH
' o TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
HUS�t
This certifies that ...Uo.e— �
.................. ...............................................................................
has permission to perform !�.........................................................................
wiring in the building of....................... `
..................................................
� 4. //l C�'•....................... :........... h Andover.,Mas .
af ........::.................................................................................. ...........
Fee...."..-. .......Lic. No. ................. .......................
...
..... . ..
E CTRICAL NSPECTOR
Check# {.
1 125 S ?
Fold,Then Detach Along All Perforations 1
COMMONWEALTH OF MA.
BOARD'O:F
ELECTRICIANS
y ISSUES . THE FOLLOWING LICENSE
. AS R REG JOURNEYMAN:ELECT., I1 A
J05>EPH P 0 CONNELL
2.0_ FA I RV t`EW DR
W I LM I NGTONh1A 01887-241.7
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12 5 90168
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Commonwealth of Massachusetts Official Use Only
Permit No.
o Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank
•M
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 WINK OR TYPE ALL INFORMATION) Date:
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his r er intention to perform the electrical work described below.
Location(Street&Number) /3 /j • .4V jV16E'r
Owner or Tenant G,r Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check A ropriate Box
Purpose of Building Utility Authorization No
- Existing Service /00 Amps (oV /<M Volts Overhead Undgrd❑ No.of Meters
New Service HCl Amps %w / 61YVVolts Overhead Undgrd ❑ N/d f))j eters
Number of Feeders and Ampacity �
Location and Nature of Proposed Electrical Work: wv- 1)1 re WL00 1,.•P
�to re-Q*d_ �X 13 e►' y+ rs;,+n z► .y c w t% t 9..
Completion the following table may be w ived 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- ElNOMOTEmergency Lighting
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 No.of Alerting Devices
Tons
No.of Waste Disposers Heat PumpNumber Tons KW No.of Self-Contained
Totals: ' ' ' "'"'""""'"*"' 'II 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
p 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: /felt', 06 (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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties o fvperjury,that the information on t is application is true and complete.
FIRM NAME: -L-e./ LIC.NO.:
�2
Licensee:
� Cf- ��,,.-►--Q,I I Signature LTC.NO.: _
(If applicable,enter "exempt"in the license nzzmber line.) Bus.Tel.No.• `7
Address: elU p, y -L0 t4 • , �. m u F Alt.Tel.No.:
*Per M.G.L c. 147,s.57-61,security work requires Departm t 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 agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed w,
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 R "�
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 0 Failed Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature: Date:
J
SERVICE INSPECTION:
Pass Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH INSPECTION:
Pass 0 Failed 0 Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: Date:
ROUGH INSPECTION:
Pass M Failed ❑' Re-Inspection Required($.) ❑
Inspectors Comments:
Inspectors Signature
Date:
]FINAL INSPECTION:
Pass M Failed Re-Inspection Required($.)❑
Inspectors Comments:
Inspectors Signature: l Date:
DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com
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The Commonwealth of Massachusetts
.fment o
Department IndustrialAccidents
P
Office of Investigations
Uf 600 Washington Street
Boston,AM 02111
www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
� f
Name(Business/Organization/Individual):
i
Address: �,r v 14..J
City/State/Zip: [�.., w� tyN ��L,v\ one
Are you an employer?Check the appropriate box: Type of project(required):
1.El am a employer with 4. El am a general contractor and I
- employees(full and/or part-time).* have hired the sub-contractors 6. F1 New construction
2.V I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance: 9. E]Building addition
5 e corporation d
[No workers comp.insurance • ❑ are W a rp radon an its
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
s myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.0 Other
*Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information.
i'Homeowners who submit this affidavit indicating they are 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.
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.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 requireclunder 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 c try der thepains dpenalties ofperjury that the information provided above is true and correct.
�! i ature: Date:
Ane#:
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.PIumbing Inspector
6.Other - - -
Contact Person: Phone#:
i
1
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-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 CoUUAOjjW0ajtbL Of Mgssachvsetts
Department ofIndustrial.Accidents
Office o£I avestigations
600 Washington Street
Boston,MA 02111
Tel,#617-727-4900 eyt 406 or 1-877-MASSA FE
Revised 5-26-05 Fax#617-727-7749
v WWMass,govA.,a
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Pp,.%fIT'Nd. 576 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP+4$oe LOT NO. cLg 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE —
ZONE GG�n I SUB DIV. LOT NO.
LOCATION 1,5 +/ nye, 1 j� PURPOSE OF BUILDING
OWNER'S NAME �[ L` NO. OF STORIES / 1 SIZE
OWNER'S ADDR SS / s L BASEMENT OR SLAB
ARCHITECT'S NAME ! l� SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME �• PAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION RP M MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �g IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
i
LAND COST
SEE BOTH SIDES EST. BLDG. COST
i wS ..SS
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
;0AN
T F D �
SUILDING INSPECTOR
LGATURE OF OWNER OR AUTHORIZED AGENT
F E E S�v OWNER TEL.#
PERMIT GRANTED CONTR.TEL.# X22- 9_ 6
119 CONTR.LIC.#
H.I.C.#
Cir S17
-- /o S2S--
v
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY _ S'ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY _ OFFICES 'LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION _ 8 INTERIOR FINISH
CONCRETE 3 1 2 13
CONCRETE BL-K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
UNPIN.
3 BASEMENT. 11
AREA FULL FIN. B'M'T' AREA _
1/1 1/2 '/, FIN. ATTIC AREA _
N_O BM'T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARDW D
ASBESTOS SIDING COMMON
VERT. SIDING ASPH.TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. & FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BILK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLEHIP BATH Q FIX.)
GAMBREL MANSARD TOILET RM. 12 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES ` LAVATORY
WOOD SHINGES- KITCHEN-SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING 11 HEATING ~
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL.
B'M'T 2nd _ ELECTRIC
1st 13rd I. NO HEATING
Town of North Andover f 40RTH
OFFICE OF ° <t``° '�,tio '
? y, a p
COMMUNITY DEVELOPMENT AND SERVICES
.146 Main Street
t,LIAM J. SCOTT
North Andover, Massachusetts 01845 ��,"4oq,;,;;:•`�5
: 9SSACNus��
Director
In accordance with the provisions of MGL c40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed,solid waste disposal facility as defined by MGL
c 111, S 150A.
The debris will be disposed of in:
(Location of Facility)
Signature of Permit Applicant
Date
NOTE: Demolition;permit from the Town If North Andover must be obtained for this
project through the Office of the Building Inspector.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Page No. of .Pages
PROPOSAL
0�suit License#122153
•y J.B. CONSTRUCTION
ca Screen Rooms Vinyl Siding
Windows >' ._ /p p� Carpentry
Painting / b O O Remodeling
Fully Insured a Over 10 Years Experience•Free Estimate
PROPOSAL 9LIBMITTEDTO PHONE DATE
.1-7-P- tip
STREET JOB NAME
S
CITY,STATE AND ZIP CODE - JOB LOCATION
We hereby submit specifications and estimates for:
-Of
/ ws�
i
t Ve
6.4 rf
WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of:
=2 C%'t,- ($ 6 .S. O J.
Payment to be mads ollows:
l�f r
I e—
Le_ or.�
All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized -
manner according to standard practices.Any alteration or deviation from above speofica- Si nature.
tions involving extra costs will be executed only upon written orders,and will become'
ecome an g
extra charge over and above the estimate.All agreements contingent upon strikes,accidents
or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be
Wortvnen's Compsnsuian Insurance and Public Liability taken out with Nationwide. withdrawn by us If not accepted within ! j days,
ACCEPTANCE OF PROPOSAL.—The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized This contract may be voided in the first 3 working days after acceptance.
to do the work as specified.Payment will be made as outlined above.
Date of Acceptance: Signature
o �
' �• �� � CONj RAC.j OR
rkljex
- H YEMEN
R� HOME atian 122153
Rots
Type " 08A 01126198
CONSTROCj14N
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02118
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NORTH
own of
0
dover Mass. o✓ 1.5
yy 149
LAKE ^ 1 1/
COC MICnE WICK V
�dSORATEO
1 BOARD OF HEALTH
MIT T.. ` Food/Kitchen
Septic System
THIS CERTIFIES THAT �..��r.� ��.... ....... L�otiS c� ti............................... on G INSPECTOR
BUILDININSP
o e .......�-Li'i=ce f��� roundati
has parmissi n to ....................... buildings on , -/.�...............
! ;... . ....... . Rough ..
to be rzcU ied w.. GV?/.P� c--f c� L �'�S�/.N.�f—'..::be J/U -
Chimney
p ........................ ............. . . y
provided that the person accepting tbis,4wrmit shal in every respect conform to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws-relating to the Inspection, Alteration and Construction of .-
Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Vdidt this Pormit. Rough
Final
PERMIT EMPIRES I\' 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONS "RUCTTON ARTS
Rough
. service
.. ..........
... . ..... �
BUILDIN SPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
_ Strut No.
—&),52 S . ke r°-