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HomeMy WebLinkAboutMiscellaneous - 15 MAIN STREET 4/30/2018 (2) aV �' O,pORTH O • ' OR h eo M cNusft. CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number n/a Date: December 17, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 15 Main Street, North Andover, MA 01845, Emerge Salon and Spa MAY BE OCCUPIED AS hair salon and spa IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: DF Finegold Trust 15 Main Street North Andover,MA 10845 Building Inspector Fee: 100.00 Receipt: 23798 /v Date. /2-/b "O 87y NORTH TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING SSACMUS� D This certifies that . . .�. . . o� . . . .!. . . . . . . . . . . . . . has permission to perform � plumbing in the buildings of . . . . . . S /k FflvL 11 v ` -. at . . . . . . . . . . . . . . . . . . . .�7.�. . . . . . . . . . . . �. , Nort2-th Andover, Mats. Fee. .A<7 .Lic. No.��3�3 . . . . . . . . . . . . . . . . . . 4,7 PLUMBING INSPECTOR Check # Z 3 MASSAC USETTC UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: A ' , MA. Date: /Z �� �� Permit# Building Location: �� %'f /� Owners Name: LC r Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential❑ New:❑ Alteration:❑ Renovation:❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ • FIXTURES v DEDICATED z SYSTEMS LU z S ~ O u M W Y O LA V1 C Z F Y Q N U W L7 C Z Z j tn X N a W Z_ W Z O Z N VQf W (y O co 'n W p H N Y Cr Q 'n Y 'n (7 _ a X x �_ Q ?� oC C of VNf Z u d J a 'nL6 0 a W O W H W J OC C v O2S O W W LU u t- x a 0 3 cx� z a 0 3 0 0. Z z 'n F-FE LU LU "' • Z. c a } '~i' = < a 'n 'n o 0 I > > 0 x o Q a a a 6 u a z z a a cc m c e U x x g g Cr 'n h I 0 3 3 3 0 SUB BSMT. BASEMENT I'FLOOR 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR BT"FLOOR ' p Check One Only Certificate# Installing Company Nam H�am1//071//07 ` n, /�� L ❑Corporation Address:fj ////� City/Town: L State: ❑ Partnership *. Business Tel: / / 0 6�Z3lJ j`� Fax: [firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ 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 Signature of Owner or Owner's Agent Owner E] Agent F] 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. By Type of License: Title ❑ Plumber Sigwabre of lAensed Plumber City/Town ❑Master Z_C/ APPROVED OFFICE USE ONLY ❑Journeyman License Number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrintLe ibl Name (Business/Organization/Individual): Address: City/State/Zip: ` �/' '�✓ ( phone Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ElI am a general contractor and I 6. E]New construction mployees(full 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 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 are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] employees. [No workers' 13.❑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 acid 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 maybe forwarded to the Office of Investigations of the DIA for insurance*coverage verification. I do hereby certify✓der the pains and penalties of perjury that the information provided above is true and correct.' Si nature: 'j/�— Date: Phone 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#: 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 nurnber(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 pen-nit 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 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 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. #617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 wvvw.mass.gov/dia 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)names address es and hone numbers along with their certificates of ppY ( ) ( ),address(es) p ( ) g � ) 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 confinnation 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 pen-nit 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 4 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 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 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 Depa tinent of Industrial Accidents Office of Investigations 600 Washington Street - Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 wvvw.mass.gov/dia The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UHI www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrinfLe ibl Name (Business/Organization/Individual): ti Address: � City/State/Zip: Z r� < tel' 'G✓ -0-l lPhone Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors J 2. am a sole proprietor or partner- listed on the attached sheet. t ❑ 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 are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 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.]t employees. [No workers' 1311 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 insurancefor my employees. Below is the policy andJob 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Si nature: '�— Date: Phone 9: ���'3d ," 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#: 12/16/2010 14:23 9786826095 DITTOPRINTING PAGE 01 2-1 -cO Date. . . . . . . • . $795 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING b�b...,e•i•'a� 1=t4tMY`+ft This certifies that . . . - - . •��� . • • • • . . . . . has permission to perform . r n- plumbing in the buildings Of . . .M�A.(4- �/L!L�/ • • • $oLon� at . . , �.h� `�= - • • � � ortb Andover, Mass. Fee. . , . :. . .1Lic. No-C •4393 . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 3 G1, ✓ / Ze f Date../t�."..5---©r, HOR7M °f t"`°:• '"° TOWN OF NORTH ANDOVER 3? f.P --. .• OL - p PERMIT FOR WIRING �SS�cMusf� This certifies that .............rl/I/lj ... '........................ has permission to perform ....... {.... 4? -...- � f� l ... . .............. wiring in the building of................1./. .. F!S?G. s/........................... at......... /�.. *v 52............................ .North Andover,Mass. .............. .. i. ....... ...... .. Fee.. ® v /N 30ZA ELE R[cALINSPECTOR z Check # f 6972 Dcylattlliclll o[ uublic �o[clu ccupancy A Fee Checxeu t — LL..–" . heave blank) ., BOARD OF FIRE PREVE11T1011 REGULATIONS 527 C61R 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance wilti'lhe Massachusetts Electrical Code, 527 CMR.12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dote 9/6/06 95* or Town of— Na -th Andover — To the Inspector of Wires: The uderslgned applies for a permit.to perform the electrical work descrlbed below. Location (Street '& Number) 15 Main Street Owner or Tenant DF Realty Owner's Address Same Is this permit in conjunction with a,building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building commercial U.11111y Authdiization No. Existing Service Amps __/ Volts Ovefhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No:of Meters Number of Feeders and Ampacity r sub-feeder cable to panel furnished Location and Nature of Proposed Electrical Work Tie-in and installed by others. I y Total No. of Lighting Outlets No. of Hot Tubs No. of Iflanslormers KVA Above In- KVA No, of Lighljng Fixtures I Swimming Pool grnd. C1 9,.d. ❑ I Generators I I No. of Emergency Lighting No. of Raceplacle.OuttelS No. of Oil Burners Gallery Units FInE ALAnMS No. of Zones No. of Switch OUuets I 'No. of Gas eurneri No. of Oelecllon end No, of Air Cond. r Total lone initialing Devices ' Host Total_,.._.. Tot - ' No.of KWr� •- .No. of Sounding Devices No. of,Disposals J I Pumps Toner , k-%' IM No:of Still Contained /AHealing Y OetectioNSoundlnq Devices Spacerea No. of Dishwashers 'I Municipal KW Local rr�-� . CtOlher No. of Dryers Healing Devices L_ Connectloh No. of No. of Low Voltage t! No. of Water Heaters It'kV Signs eallasts wiring ,,• No. Hydro Massago 1Lba I No. or Molors Total HP e OTHER: INSURANCE COVERAGE: Pursuant to lne reourremenis of I,tassachusens general Laws ' = NOtris = I I have a current Liability Insurance Policy including Completed Opera ic11 youChave checxovet-190 OresdYES. Pletastn @ indicalethe type of coverage by have submitted valid proof of same to the Office. YES _ NO = y Checking the appropriate box. pities• Soeci IExp°aupn Oa1e1, INSURANCE S BOND = OTHER = ( ^) Estimated Value of Electrical Walk S Find Work to Slan Inspection Date Reouested: ovgn Signed unser the Penalties of p•rlurY: LIC. NO. 1 A3-Q2A_ FIRM NAME And C NO. License* Robert JIM- BrdnCa Slgnawr• �� 47 995 eus. - 206 And _ All. Tel. No. Addressnol ;,. i its OWNER'S INSURANCE WAIVERI Laws. and tnattmy a gnawre lcensee d Inas cermn opacauon c a ves this•reou gement.ownerwval•Agfnle• quired-by MassaChuserls Genera (Please ehee'k"ono► - PERMIT FEE s Teleonons No. r{�S lSignawu or Owner cr Agentl please N f i s e