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Home My WebLink AboutMiscellaneous - 170 HICKORY HILL ROAD 4/30/2018 (2) / 170 HICKORY HILL ROAD 210/062.0-0102-0000.0 l i i I I Date. "t f NORTH� oar°•,�``':•_�.."°off TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACNUS� This certifies that .. ..E.s.. !?... ......................... ............ has permission to perform .... ..' .. " wiring in the building of.. �?..`... .. �.!1. Ups/1�............................. � // //. .... at./..,7A....1 ? lL'v1... ,..... ....... l.�.......... ,N rth Andover,Mass. FeeS..o............ Lic.No.............. ......................... . .. .. . ............... ... ELE ICAL I pECTOR Check # -46 ', 7493 Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services 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: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives no ice of hrisoher intention to perform the electrical work described below. L ion(Street& Number) D l�C� c{ Owne- or Tenant (;at 1-J CGn ,ie �r` Telephone No. ner's Address 1-70 1—lftkqfx Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Pe S Utility Authorization No. Existing Service –1-5-00 Amps /)0 Volts Overhead 0 Undgrd R 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 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. o mergeney Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners No. of Detection and x d Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I 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.o Water KW No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: �J {r� No.of Devices or Equivalent OTHER: lZeloo C /Yr'1 l/ Q. rch 7 /!'I�' S C-rA(- 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: 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 a td%naies,l/tof perjury,that the information on tis application is true and complete. FIRM NAME: �yYf � ?/ e-crP 141 LIC. NO.: Licensee: in I SL Signature � LIC. NO.: (If applicable, enter "e. rcense nurj�ine.) pt"i th k�lcBus.Tel. No.: Address: f� �S >�( d�it /U cSCS Alt.Tel. No.: Per M.G.L c. 147, s. 57-61,security work requires Department 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: P $ } Q The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 $` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractorslectricians lumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 4JAsr"1Phone #: 6o3- i Areou an employer? Check the appropriate box: Type of project(required): 1.Etam am a empl with 1 4. ❑ I am a general contractor and l 6. ❑N w construction employees and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 1 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.❑ 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.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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. Bel w is the policy and job site information. c Insurance Company Name: J �ei►� of �e�vt d �c� Policy#or Self-ins. Lic. #: q Expiration Date: Job Site Address: 17 c / City/State/Zip: vP 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r the pains andpP1,94ties of perjury.-that the information provided above is true and correct. • Si nature: P Date: —0 Phone Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Gelinas Structural Phone 978.465.6436 Daniel L. Gelinas, P.E. Fax Line 1: 978.465.5160 579A North End Blvd. Salisbury, MA 01952-1738 email danlgelinas@adelphia.net 07069 G July 17, 2007 Larry Palmisano• Contractor fax 978.762.4762 J R Builders phone 762.9780 x1223 599 Canal St. email jrbldr@comcast.net Lawrence, MA 01840 cell 508.509.7593 SUBJECT: revisions, Condurelli residence 170 Hickory Hill Rd. Dear Mr. Palmisano: Per your request Gelinas Structural Engineering LLC (GSE) meet with your representative on site today to review the changes you made to the framing plan drawing no. SG-1. Basically Header H22 was changed to a lower three ply 1 3/4x 9 %z LVL that runs directly below a higher two ply 1 3/4x 16 LVL. Provided the H22 lower three ply 9 '/z LVL is sheathed to the above two ply 16" LVL with one sheet of 3/4"plywood the field modification is acceptable and meets code. Nailing schedule to be vertical rows 6" o.c. with 6" o.c. horizontal rows [thus 3 rows horizontally on three ply 9 1/2]. This was discussed on site with your field representative. Also discussed in the field, GSE requested you double check the interior post is blocked to the foundation wall,platform framing is acceptable. Very Truly Yours, �H of MASS'�C (MI101) tiGN Daniel L. Gelinas, P.E. �� DANIEL L. vGFLINAS G letter changes 7-17-07.doc p STRUCTURAL No.33994 �q- RFGIS S$I P& tvELINAq aTRuc-ruRAL ENGINEERING LLC Structural Engineers:Residential,Architectural,Commercial/Industrial Residential Designers:One and Two Family Dwellings ' Phone 978-465-6436 579A North End Blvd. Fax 978-465-5160 Salisbury,MA 01952-1738 email:danlgelinas@comcast.net f , C s 402 --�'/ o'r .i ,� i I I I i -t - �;°� ;� ,+ +�, rr-; f / � ��, r � 'tl , �� ,�� r �, `�,s� � � -, '�-.'. � Oar� . �• '` ",� �f,�'� 1 _ � <, �, � € .�� _,.. ,t�=� 'i �- .� - �. �� -:��"- _ II i ,.,;, ry �� , �_ . ��. -,e. ��_ . .��