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HomeMy WebLinkAboutMiscellaneous - 163 STONECLEAVE ROAD 4/30/2018 163 FONECLEAVE ROAD 210/104.B-01 34-0000.0 I �` C.ornowrawea z 7 Xas3Au6ds official Use only Permit No. Occupancy and Fee Chedwd BOARS?OF FIRE PREVENTION REGULATIONS, gey. iwj eave blank) APPUCATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PANTNAW OR YYTEALL-LYF0PMT10A9 Date: Ie th Po Ci ©r Tows of DI' X17"1 t'.Y" � ctor of Wires. By this appy on the undersignedgives notice of l is or he.rkkution to the elecwieal work d�below. Location(Street. Number)J&3 n 14 Owner or Tenant S Telephone NoL91LF Owner's Address (.SAA IC b this permit in conjunction with a building permit? Yes F1 No (Check Appropriate Bog) Purpose of Building Utility Authorization No, Ezisfing Service Amps I Volts Overhead €3fa4prd-[] Nm of Meters New Service Amps 1 Volts OverheadEl Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: completion o the followingtable Mg be waived by the A!5eecwr of Wum NO.or Totat Wo.of Recessed Luminaires No.of Ceiil-Susp.(Paddle)Fans Transformers KVA �fNo.of LuminaireOuttets No.of Hot Tubs Generators KVA me enLighun o.of Luminaires Swimming Pool Abo le a In-d.. Q. o.ogaffe Units cY No.of Receptacle Outlets No.of Oil Buruers FIRE ALARMS No.of Zones 'fjo.o€Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Coad. TOM - No.of A Devices No.of Ranges Tons - No.of Waste Disposers Totals _ umber[Tons o.o Self-contained Detection/Alerting Devices Municipal No.of Dishwashers of Space/Area Heating I(W Local Q Connection Q Othex Heating Appliances Security Systems:' No.of Dryers g KW No.of Devices or Equivalent No.of WaterNo.of o.of Data'Wuing: Heaters KW signs Ballasts No.of Devices or Equivalent Telecommunications No.Hydromassage Bathtubs No.of Motors — Total�' No.of Dez•ices or u' eat k"OTHER: ,Qttaeh additional detail if desired,or as required by the Inspector of Wires- Estimated Value of Electrical Work: (When reqTdred by mumcipal F°hCY) Wt rk to Start inspections to be requested in accordance-with NEC 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 coverage or its substantial equivaieart The of liability insurance including"completed operation" undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CmCK ONE: INSURANCE 00 BOND•[I OTHER F-1 (Specify) n as true orad eomplet� I certify,ander the pains and penalties of perjury,that the information on this apFii�° F1Rl�I NAlt'IE:M EMi E IFCAri Ca t S r i t s _ LIC.NO.:'263 Ra A 31 Licensee: KP Y1 d%P!An YC �Signature LIC.NO.: (if applicable Aenle "exempt"in the license lme) Bus,.Tel.No. -�fQta-?EI(o'� Address• � Aft.TeL No.PerM.C7 L. 7,s.57-til,security work requite of Public Saffety"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 0 owner ❑owner's agent. Owner/AgentTelephone Na. Ed ll�'F� . 55, Ofd Signature i2�3�112. Vt �ncUl 1 2.13 1Z (`�+ ►ti�j cru - `m e_, F Date TOWN OF NORTH ANDOVER s PERMIT FOR WIRING o'i� 'C ass lec�x4 C I This certifies that . . . . . . . . has permission to perform . ! .� . . . . . . . . . wiring in the buil ing of . .".1.L !� . . . . �. . . . . . . . . . . . at . . . . .I.�P.�. . fA.b)�._. . . . . . . , Nth Andover, Mass. n p Feed Lic. NoZq Z Z: . . ELECTRICAL INSPECTOR i Check# 340 11334 r . 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 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.thelnspector_of_Wires abandoned_and.invalid.ifhe—. or she has determined that the authorized work has not commdnced or Itis 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 entitystated 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. ule 8—Permit/Date Closed: ��-lJ- �`**Note:Reapply for new permit 0 Permit Extension Act—Permit/Date Closed: _ \ The Commonwealth o. Massachusetts Department of Industrial Accidents = Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organ tionandividual): Alog f h 4AI r,- �'L E [g l c& Sia a!/l acs. C, Address: �/O e i0/ City/State/Zip: E"LG! Phone#: So Y 7y67 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a with employer 4. ❑ I am a general contractor and I �— 6. New construction employees(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. employees and have workers' cotri"- insurance.t 9. E]Building addition [No workers comp.insurance p required.] 5. ❑ We are a corporation and its 10.tffElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions right of exemption per MGL ��nyself. [No workers comp.. 12.F]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 41 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site informtation. Insurance Company Name: ((AX 12 lUk fA v C e' 00y Policy#or Self-ins.Lic.#: V C / 3 G 62 Expiration Date: :z zgg r� Job Site Address: City/State/Zip: Attac"copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a � as e9 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 cerhiun apains an o erjury that the information provided above is true and correc& Si afore: --- - --- - —- ------ - -- —— -------- Date Phone#• -0 2' ((y� 74// 7 Official use only. Do not write in this area,to be completed by city or town offciaaL 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#: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM`PLUMBING WORK CITY Pmt'' MA DATE PERMIT# �) JOBSITE ADDRESS I OWNER'S NAME Pte" P OWNER ADDRESS TEL U"(O S--(DD FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL@"" PRINT CLEARLY NEW:.C] RENOVATION:(3 REPLACEMENT:[ PLANS SUBMITTED: YES NO[] Z FLOOR- BSM 1 2 3 _ 4 -- 5 1 6 7 8 9 1 10 1 11 1 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM. DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FQOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY.. .ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING BOTHER INSURANCE COVERAGE: I have a.current liability insurance policy or its substantial equivalent which meets the requirements of I19GL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY 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: OVINER D AGENT SIGNATURE OF OWNER OR AGENT !.hereby certify that all of the details and information I have submitted or entered regarding this application29�T to the best of my knovAedge and that all plumbing work and installations performed under the permit issued for this application N be iartin vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME hiliip J Durfee LICENSE# 13774 SIGNATURE MPQ JP[I CORPORATION# PARTNERSHIP[]#=LLC 152 COMPANY NAME Plumbing&Heating LLC ADDRESS A Huntington AVE CITY A.Yarmouth STATE MA ZIP 2664 TEL X78 FAX 8-258-0592 CELL 8-8Q1 EMAIL hil@durfeeplumbing.com Lffa , C� I 09738 Date I L . . •, 1 i TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING T�is certifies that % has permission to perform . . G.C .. (���V�!�, plumbing in the buildings of. . . . . . . . . . . . . . . . . . . . . . . at . . .I.( o��. . . J!Pc�..a. . . d . . ,North Andover, Mass. Fee .'252—q). Lic. No. . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check#252.93� _-GOM�+'tONWEALTH OF MAS.SAOHUSEtTS_ AMUS t;TN Of MASSA PLUMBERS AND GASFITTiERS - -- :, .• t E1VSEa AS A JOURNE R f P�.UMBER f)NIKAfs • • "• SPITTERS. MUMS THE ABOVE ucENsE To: $ERS. aND GA PLUMBER. :. s s PMASTER I'HILLIF J DURFEE �ICEt�SEU AS A avE uc,_NSE TO:. . . - `.ISSUES THE� ST �~ J IT�RFEE _ - ; MA 0263$24I�' - 'F�}: _ 638=���� : : -- -:=-26232 •OS�aia .-: MINIM M. a 5/ 1 14 • F K-rhea Uetnh Abng AR Perforations T$TT4 • ' - oetad+Aw.,9 ertoratid+s :==.f :CflMM©NWF-ALTH OF MASSACHUSETTS- ---i KUMBERS AND GASFI-IRS. -` REfi�STERED AS A PLUI C CORK ISSUES THE ABOVE LICENSE TO: PHILL.IP. J DURFEE `i)trRfE -PLUMBING � HEATING:. LLC � 5 I"i.A7C* ST MEN41-S NIA 02630=2 17 � =3152 0.5/01/14 -184.63 :, 10/11/2013 12:OOPM 5AX Z0©01/0001 The Cornmo> cah*of Afassirckmeds • . ' be�rardrset�t of�gdrra�rial�cciderrta . . Of�Ce pf I�e��ig�Gions - 600 Wa&ingtm S&ed Bustin,MA 02111 www-waguv1d& Workers'Compepsa on h4arance Affidavit!Buflders/Coxatracbm/FIectnman Tlmbers A lirt Trifor>yiatian Please Pi eiblv aWllu Adess•' ��hme070C' # / y Are u an employer?Check.fhi appropriafe•bt �pe of ect 4. }� 1 am a genial ca ftUor�d I F='o3 ( = 1. a�a amployex 6. Q NLV=kuctaoat czploym(fct and/oz patt )_e have himd•the�ctms �:❑ za�a'a.olep�opraemzorpffiiat+r lssle-1•autlse� cdslcrt: 7••940=&�g '- ship aad isaFe nn employees These s -cozattsv4 .8. t�ployam aril haft wo6mW working dor me m caaciiy. t, 9, Q Btu'Idmg addi�avl �To�as+arkM'cozup.ias�aaace �' 10. cal or addzlzons „ } 5. Q We are a caiporafion and its QP 3.01 am i h'0Mw =•doing all WO& often:have e=ciscd 9wir 11.�?1crm17ing repay or auitlifions myself[No workers'COMT, right o£ex=ption pts M L 12. Rtot , MSMUwa rMreti�t A 152,§1(4),mdwo ha't=c no Q • ', ' eanployees.[No workeas' 13.❑Qthtr C.Mv.inscaattce regaumd.I �Aay 8e finM e t=int also S o*the=tkm bdvw shovkg Ow wokae =Wficr mo .• w t�menwaers who s remit das atuMt iaT=ft they=doing alt work and hin outside conb sss awsc auSa ra �sdava g , bra ttat shack this bM tam M ad d=4 zbwt&awr ng the mtat of 9c sub•camhactors and start whodmornaftm modes tan . �Cyara. Yf��t3haveemployees,$��ratthear wor#aa'somp.PnEoY>yumbrr. - Iroil an=Tloyer ditat ie prot>ixxg Mwkew et►mpamadox immmee for my=Tkyee& Belotf+is the poTiap andjab a7te Tustaaacc CompatlyK=n Policy#or scaf ias.T..ic. 7 _32- Job Sit.Address Asch a eopp of the wor*ers'compensation policy dedarataon pa ggs'(ahowmg the policy nmw and egdrafian date). Fafte,to sector:coves p as xequirrd.tinder Secd m 25A of MGI,e. 152 can lead to the iiupoddon of C6Mj081 penalizes of a f me tip to$1,50D.00 sadlor cine-year iapiso=mir,as wcU as cion pe�in ft fm' m of a STOP WORK ORDER and a fmc of u*to-$250.t?0 a day agaipt fhg violator. Be advised that a copy of this sta t may be fmw to Sw Office of Yt19 boos of the MV§M Verifirsiirm. I'do&ereby c tlre'pui and pend&s of perjz"did theWvrma#an provided olinds Je*,A aed CarrECL SDaft. Phoue#: _ `5 C3 �" (fit 1• � t j _ O use only. Do nat write fn this ww%to be eotrrp, ri bp.rev ar town olftad - City or,Toww yermitlLietmse# IwWwAuthorify.(cirele one): •1.Board of Heaifh Z.DWIft Depart=t 3.City/` avcm Clerk 4.Mechlcal Inspector 55%PI=bntg Lapector d.Other — cu faLt Person: plit»ae :