The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 154 REA STREET 4/30/2018�� 154 REA STREET � 210/098.A-0011-0000.0 Date...:5:',o-d C�...... f NORTp, TOWN .OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACHUS� This certifies that � 5 �� .................................�. ................... .............. .........p.... ..... has permission to perform ...... .. �y� ; ! / s r- I.............. ....... ..c ........ .I. ..... wiring in the building of.... !..'..... �� - .......................................... S7— at.............1�..... .............................................� .North Andover,Mass. ab -� t Fee.... . ........ Lic.No. -- . ......l ...... ... ,�r .................. .. t EL CTRICAL INSPECTOR / � Check # tof3 8041 j 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 " on the prescribed forin.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 G.L.c.143,§3L. notification of completion of the work as required in M. Permits shall-be limited as to the time ofongoing construction activity,and may be-deemed-by.the.Inspector_of_Wires abandoned-and_invalid_ifhe—_. ._ 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 tor reasonable cause.A permit shall be terminated upon the written request of either the owner or-the installing entity stated on the permit application. . J 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 toob romote P J 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. ffDPermit le 8—PermitMate Closed• ***Note:Reapply for new per Extension Act—Permit/Date Closed: j — Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.ki z—, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: CA /1L -6T 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) J 6—y I {e j Sl-' Owner or Tenant sc,C a e Q Telephone No. g 5 Gal Owner's Address Is this permit in conjunction with a building permit? Yes 11" No ❑ (Check Appropriate Box) Purpose of Building fr TC h P w Adrlwo nJ Utility Authorization No. Existing Service 2Q6 Amps / 2 Volts Overhead 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: ,r Completion ofthefiollowing table mg be waived by the Ins etor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o.o mergency Lighting / g nd. E] nd. ❑ Battery Units No.of Receptacle Outlets j No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners.,: No.o Detection an Initiating Devices Total No.of Ranges j No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number on .. .s ........ o.ofSelf-Contained Totals: .. Detection/Alertin Devices No.of Dishwashers / Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW SecuritySystems:;; No.of Devices or Equivalent No.of Water , No.o No.o Data Wiring: Heaters Signs Ballasts I No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunications irin : No.of Devices or E uivalent f OTHER: O Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: /OV6 (When required by municipal policy.) Work to Start: &-/7-0� 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 andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: -A,0 �, �„�,�/ Signature LIC.NO.: 3.70 6�' (If applicable,enter "exempt"in the license number line.) Bus.Tet.No.' 971-2574M7, Address: �,(S� ��y iQ„/ fj[ ff��ed2► Nl/t, Alt.Tel.No.: 97f--245-4739 *Per M.G.L c. 147,s.57-6 l0ecurity work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAN : I am aware that the Licensee does not have the liability i s rance coverage normally required by law. By my signs ow I hereby waive this requirement. I am the(checkone owner ❑owner's a ent. Owner/Agent Signature Telephone No. 6n5-1C Al PE"I E. $ b F �J� r 7447-, n 8614 nlc �� t 3 -12, PYI-t q The Commonwealth of Massachusetts Department ofIndustrial Accidents Office ff� of Investigations 600 Washington Street .Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Legibly y Name(Business/Organization/Individual): C�/�✓[�t'�y (..`i tC�J t .Address: . y /er4 cP7 ` • City/State/Zip: j4tti/)op,,_ Phone.#: Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4. Q I am a general contractor and I Type of project(cequiredj.` employees (fiill and/or part-time),* have hired the sub-contractors 6. ❑New construction 2.LX1 I am a sole proprietor or partner- wed on the attached sheet 7. Remodeling . '! p and have no employees These suh contractors have working forme in any capacity. employees and have workers' 8' ❑Demolition [No workers' comp.insurance comp. insurance.t 9. ❑Building-addition required.] S. We are a corporation and its 10.7 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11,(�Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.7 Roof repairs employees. [No workers' 13.❑ Other comm. insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeoarers who submit this affidavit indicating they arc doing all work and them hire outside cont=tors must submit a new affidavit indicating Contractors that check this box must attached an additional sheet showing the narne of the sub contig tors and stn such. employees. If the sub-contractors have 1 to whether or not those entities employ they must provide their wor hes have leers'comp.policy number. I aman employer that is providing workers'compensation insurance for my employees information. Below is the policy.and job site 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 tine 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 DL4 for insurance covera a verification. I do hereby certify under t p ' s. nd penalties of perjury that the information provided above is true and correct Si ature, ` Date: —/r/—v v Phone#: _ --------------- Official. only. Do not write in this area, to be completed by city or town official City or Town:* Permit/L,icense# • Issuing Authority(circle one): :1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical InspecEPlumbingctor 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"ever ry state or local licensing agency shall withhold the issuance or renewal of a Iicense or permit to,opera'tem business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co mplianee with the insurance coverage required." ' Additionally,MGL chapter 1,52,§25CO)states"'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If.an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 youare 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 sureto fill in the permit/lioense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 thathas 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 io 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 Commonwealth of Massachusetts Departrinent of Industrial Accidents Office of Investri ptions 600 Washington Street Boston, MA 02111 _ Tel.#617-727-4900 ext.406 or 1-877 1MASSAFE ` Fax # 617-727-7749 Revised 11-.22-06 www.mass-govlclia 9261 TOWN OF NORTH ANDOVER O� ,.ae .•,ti0 PERMIT FOR PLUMBING. 'risSACMUS� / s � This certifies that . . . �j��a/.hl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . ��!�!`� A . . . . . ,dart plumbing in the buildings of . . .rN?4$. . . . . . . . . . F at. .1..5 ,t��i , .•57� . . . . . . . . . . . . . . . ..,North Andover, Mass. PLUMBING INSPECTOR Check # �� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: Oy _ , MA. Dat e: I s ZU Z Permit# g S l �2t� S4 _jw�rti`t Ch t k cs Building Location: Owners Name- G ' Type of Occupancy: Commercial ❑ Educational❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes❑ No ❑ FIXTURES 0 � O Y z N CAI Cn _j in _ tu z lu W � � D! r � i-- cn � p � o m a ju. „ Q P z } 2 n �, r� a --� Q a vi z w e, O OH n � a ca a ¢ L d ° a z o v ¢ m o o W W o I- Lu Lu o f oo L w .. o SUB BSMT, BASEMENT 1 FLOOR 2 FLOOR To FLOOR --Zm FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: ❑Corporation Address: 9a Q(ALJi7_tj(J S_+#off City/Town: 1-.Owe State:t�'I I Zip Code:t:j ❑ Partnership Business Tel* o04 - O`1 ell: 5 e Fax: ❑ Firm/Company Name of Licensed Plumber: \�v L v.J - 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-W-11 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 t Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and lnfnrmation I have submitted for entered)regarding this application are true and accurate to the best of 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: 14L_` C Title ❑Plumber Signature of Licensed Plumber Cityrrown 'Journeyman Master License Number: APPROVED OFFICE USE ONLY) Flee COMMOmPeelth OflMassach setts Deparhnent of IndustrialAccidents Office ofInvestigationx I Congress Street,Srdite 100 Boston,.lid 02II4 2017 IPlinv.Inass.gouldhi Workers' Compensation Insurance.Affidavit: Bu:&de>i s/Countlractor s/PU+lect riciansfplan��er s A>p>plica,raf�fu>rxnatio>m 1 Please Plriraalt ekibly Name (Business/Organization/Individual): e-u�,,J Elk's Address: Z Grtqw Fj,-L-) 1 City/StatefZip: �w21( MA , QJ �S SSI Phone#: c17 g` 0�0`-/ Are you aim employer?Check:the appropriate box 'Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I have hired the sub-Contractors 6. ❑New construction . �mployees (full and/or part time). . 2. I am a sole proprietor or partner- listed on the attached sheet 7. []Remodeling ship and have no employees These sub-contractors have g_ .❑Demolition working for me in any capacity. employees and have workers' cam ?n�,?,�„oe$ 9. ❑Building addition [No workers comp.insurance p- required_] 5. ❑ We are a corporation and its 10-[]Electrical repairs or additions officers have exercised their plurnbin repairs or additions 3.0 I am a homeowner doing all work 11. g p myself- No workers' comp- right of exemption per MGL 12.❑ Roof repairs insurance required.]t C. 152, §1(4), and we have no employees.[No workers' 13-❑ Other comp.insurance required.] Any applicant that checks box u1 most also fill out the section below showing their workers'compeasation policy information. t.Homeowoers-who suhmitthis affidavit indicating they are doing all work and then hire outside contmctors mast submit a new affidavit indicating such. -TContractors that cbecic this box mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees_ If the sub-contractor have employees,they mustprovide their workers'comp,policy number. t I wiz an eYnrployer teat is providing 3Porkers'con!pensadon hisuran cefor my employees Below is flee policy and job site i12fOTIt datTOlt- - Insurance CompauyName: Policy#or Self-irLLic.#: Expiration Date: - t Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy ember-and expiration date). Failure to secure coverage as required under Section 25A ofMGL a 152 can lead to the imposition of criminal penalties ofa. fine up to$1;500.00 and/or one year imprisonment,as well as civil-penalties in the foir of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for.insurance coverage verification_ F do hereby cerci u! der the aiits iutd eitaldes of 'rtry t/iat the inforn:niioitprovided above is thre and correct Date --Phone 9: Official use only. .Do not write in this area,to be completed by city or town offzeia,L Citjr`_orTown: Permit!rLicense-9 Issaing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town'Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othei Contact Person: Phone#: F COMMONV1/EALTN OF MASSACHUSETTS ` LICE;N$ED ASA JOURNEYMAN pLUNI6ER`1 fSSUES THE ABOVE LICENSE 92 C.RAWFORD. .ST i fl 2 , LOWELL �, MA 01854 2712 } i 31114 05/01/12 788383 <f i Date. f. . .�G :r✓/ No 0.4 VOR'"stip TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �,SSACNUSE�This certifies that . . D IA . 1. .� . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . .. . ...!. . . . . . . . . . . . . . . . . . . . / at . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee. ./ Lic. No.. .' . . . . . . . . . . . PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO..DO PLUMBINq j (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location ��/ �1� S T Owners Name l P S Permit# Amount t- Type of Occupancy New Renovation Replacement P-71 Plans Submitted Yes No FIXTURES r � 0-41Cr � acc = Crd a, el g x W a a d d SUEWSV)C BAER" YT IST R m 24D FLOM i 3M FLOQt 4M RaR 5M FLOOR 6M FLOOR 7IH FLOQ2 SIH FLOOR (Print or type) �� L� y� �,` �t Check one: Certificate Installing Company Name pr /7 ❑ Corp. Address �O , S FiPartner. Business Telephone G Finn/Co. Name of.Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance ignature Owner F� Agent F] 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 iri compliance with all pertinent provisions of the Mass etts 4ng Code and Chapter 142 of the General Laws. By: FigiraTure of Licenseaum er Type of Plumbing License Title City/Town License Number Master uI Joumeyman r-1APPROVED(OFFICE USE ONLY Date............ .`............. 4 MO RTI{1 TOWN OF NORTH ANDOVER. PERMIT FOR WIRING . ,SgAC11U5E� This certifies that .*.. has permission to perform -.... `.> .- .................................................. 1 wiring in the building of .,� ::�f: ! ............... .................................................... �" �;at t��.`f... ........................................... .............. ,North Andover,Mass. Fee ............. Lic.No.............. ................ ELECTRICAL INSPECTOR Check # �' j THEC01 0AffF.4LTH0FMASS4CRUSEMLOccupancy Office Use only DEPARTiYIDVTOFPUBLICS9F= �-V BOARD OFF7REPREYEW0NRWMTIDNS527CtfR 12:b10 es Checked APPLICATION FOR PERMIT TO PERFORMLLEO CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRAT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant ZA a'1 PS Owner's Address /5?�_Tp .$�. 04--M /l n d at/ .r /774, Q/ 8�� Is this permit in conjunction with a building permit: Yes No r7 (Check Appropriate Box) �— Purpose of Building Utility Authorization No. Existing Service Amps`/ _Volts Overhead Underground No.of Meters P.ew Service Amps i Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4,1 Jingood co) "A beC4 V.,L No.of Lighting Outlets No.of Hot Tubs No.of Transformers, Total No.of Lighting Fixtures KVA Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones � Tons No.of Disposa s No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local MunicipalOther No.of Water Heaters KW No.of No.of Connections Si s Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- it moeCotaage Aast�alttotheregt�arlads�h da CoxiElLaws Iha�eaastecrtLiabtlityht�r�oePbl>Lyarh>dutgCrn�le6e C'ae�ecrits >tiale:privala YES Q NO Ifineabnkcdva6dpmfofsmxtDtheO6>of-- YES NO If}whawdteckedYES�pk=ir*thetypeofooaaagebyamckwegthe INSURANCE BOND OTI-)FR (Pl=Spo* . FmDaie Fst�d Vahleat�7aetlid Wade$ WctictoStatt hs{IaciionDtl�eRat�led Ra>gh FinalSignedutxlaTiePa"m*ffivay. FIRMNAME /U Imo} LkmseNTCL Ltoa /ri 1-�.. .�.2GL�� Swim= er=/rq-f a('l r _ lit�tSe b J 7 0 C BtsbnTdNa 7 Fl 219 Address,SSA 10S-17)APrAn Z IS % Alt.Tel.Na � I OWNER'SINSURANCEWAIVER;Ianaw=ttrtdrL=isedommthmetheirranxa orisiegrrdlatasm4LmedbyMasmdasemCateai aws and8�atmyssg�ontttisparr>�1mwai�tlzsl:�a�. , (Pl�eckOwner Agent Telephone No. 7 '� �f6 2 PERMIT FEE$