HomeMy WebLinkAboutMiscellaneous - 18 AUTRAN AVENUE 4/30/2018 (2)N
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Date ... 2.-2.6 ... 13.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.............J.,44,,..4......... DIE7V,TQ1V....................................................
has permission to perform .... w.e.-.e ....... �2 l.� /K'
..............................................
wiring in the building of .................... �tJt1�Q...s.................................................
at .......j$ AQ. X/ft./ ................................. North Andover, Mass.
Fee.%.5�5 C " Lic. No. N -5Z09 -
Check # 6
I14.17
E ECTRICAL INSPECTOIf ��
1
: —A
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank
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: Z - 2-1 - /33
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) i t? /9 U 'rr (fL. 14 /4 l/
Owner or Tenant <10 I Ob Y?4O r Telephone No. 7
Owner's Address 'S' ck- �-Mc- 72—Y 7 7
Is this permit in conjunction with a building permit? Yes ❑ No,,�ff (Check Appropriate Box)
Purpose of Buildings U Utility Authorization No.
Existing Service -10 0 Amps /2 Volts Overhead Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
No. of Meters /
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion ofthe following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Cell: Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above [j In- ❑
rnd. rnd.
o. o mergency Lighting
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
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
N_ umber
Tons
"' """ ""' ""
KW
""'.................
No. of Self -Contained
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 KWNo.
Heaters
of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wtres.
Estimated Value of Electrical Work: �� (, r' (When required by municipal policy.)
Work 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 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 ASpalns and penalties of perjury, th t the information on this application is true and complete.
FIRM NAME: t+ 14 yr,�c LIC. NO.: -10
Licensee:
_ �gh LTC. NO.:
(If applicabld enter "exempt" in therise number line.) �/ Bus. Tel. No.• 'Y
Address: _ _� st-e _ t) 0 f1-0 / 5 <-, r ®(/- Ad2a (� 1�c \ 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. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent q 7 z!_5— f', e
Signature `-� 66 a ep one No. PERMIT FEE: $
❑ 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 ti
notification of completion of the work as required in M.G.L. c. 143, § 3L. I `
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 i
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was I
"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 EN
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass 0
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com
S
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
IV 600 Washington Street
Boston, MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ( CC, 1J 1 !`�7 �-2✓l ��
Address: 2 Z J�l��() 4 641
City/State/Zip:Ao PT Awjo ✓ �e/' /uA,= Phone #: � % `�(y
Are you an employer? Check the appropriate box:
Type of project (required):
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
6. El New construction '
,(employees (full and/or part-time).*
have hired the sub -contractors
7• ❑ Remodeling
2. �(J I am a sole proprietor or partner-
listed on the attached sheet. t
/ ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
g, ❑ Building addition
[No workers' comp. insurance
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
required.]
officers have exercised their
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.] t
employees. [No workers'
13.[i Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submit this affidavit indicating they aie 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 thepolicy 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 requiredunder 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 ceAfify under the pains and pepkes ofperjury that the information provided above is true and correct.
?/ 6
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/License #
2.-zf--1
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other - -
Contact
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 ofpublic 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 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
604 Washington Street
Boston, MA. 02111
TeX. # 617-727-4900 ext 406 or 1-877rMASSAFE
Revised 5-26-05 Fax # 617-727-7744
wwwaMss.govldia
Location �� U �✓A N ��
No. Date
NORTH TOWN OF NORTH ANDOVER
I: 9
Certificate of Occupancy
$
��a ° • Et
swCHus
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
r
Check #
A
17294 Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER:' / DATE ISSUED:..:
SIGNATURE:
BuflEn—g Commissioner/IgEpwtor of Buildings Date
SECTION I- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
n `
I`
Map NunPvr Parcel Numb
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning Dislrid Proposed Use
Lot Area (sf) Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Regaired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of
oo�f/Record
Na a (Print) Addr ss for Service:
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Si nature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Livens d Construction Supervisor:
License Number
Addre w-
Expiration 15ate
afore Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
i
Company Name r�
1
Registration Number
?'
'Address
r� `
Expiration Date
nature Telephone
C
MU
0�
r
SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 6 25c161
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Pro osed Work check all applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
_1 t ations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
t
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIAL :USE
s
1. Building O�
6 �a0
(a) Building Permit Fee
Multi lier
2 Electrical
(b) Estimated Total Cost of
Construction
3 -Plumbing
Building Permit fee (a) X (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
,.
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIlVMERS 1 2 ND3RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
f
w
Q
North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 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
c11,S150A.
The debris will be disposed of in:
(Location of facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
v
i
-7k �orn.noo:��sea/C�a o� /l/iaaoacluiae a
BOARD OF BUILDING REGULATIONS
*;
License: CONSTRUCTION SUPERVISOR
Number: CS 034049
Birthdate: 12/08/1923
Expires: 12/08/2005 Tr. no: 12443
Restricted: 00
MARIO T CASTRICONE ��
31 COURT ST t..i -« o -e
N ANDOVER,
MA 01845 Administrator
:' � ✓Ire i�o�irmzonurealii o�'✓�daczcl..cae%�
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 403317
Expiration: 7/7/2004
Type: DBA
�C+ASTRICONE ROOFING & SIDIN
Niano Castricone
31 Court St.
N. Andover, MA 01,8451
_-�-----�_
r.It A.'
TEMPLATE #1
(ATTACH TEMPLATE #2 HERE)
TEMPLATE #1 (FIRST FLOOR) - PAGE 1 OF 1
Castricone Roofing & Siding
REPAIRS FREE ESTIMATES
Telephone (978) 682-4266
l..
G�MARIO CASTRICONE
31 Court Street, North Andover, Mass. 01845
1'
I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary
materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and
conditions, on premises below described:
Owner's Name........ptwd...... .:41w/n'. r<...............................................................................................................................................
/P",
Job Address...... ... '..... Ac Stat .......................
SPECIFICATIONS
.�..! � ...::........... ...
.... ....: � ..:.. �' *:. ...... ...........
.............�..i...
....; ........
...�,,D.
.............j ..............� .... ��� ��.. �,,���-.. ... ...> ...........
� ................ ..... /. _ -- ............
...... . .:...: ..... .
........................................................................................................................................................................................................................... ..........................
.............................................................................................................................. ................................................................... . ........................
......................................................................................................................e.r. ..� Q::::::.:.:.:......:.....................:.....:::..
........................................................................................................................................................................................................................................................... .
..................................................................... ::................. ........
.. .................
Materials and labor to Cost $ ................................... Payable %on .............:..................and balance in...........
monthly installments of $ .........................................each, payable on ... ..................................day of each and every month thereafter until paid
in full (..............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligation and
completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpa
immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses,
addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith.
It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estate
of the parties.
The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(. -
PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused.
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is th
contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signe
by all parties.
Cover attic storage cleaning not included.
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read ar
the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements ar
understandings of said parties are contained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in ration, C
IN WITNESS WHEREOF, the parties have hereunto signed their names this ......... day of....� 1..........,
Accepted: >
Signed.........c :........
.....6�`.. . . ......
Owner .
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT)
Per...' ..................
Representative
Signed......................................................................................
Owner
Signed......................................................................................
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�> Telephone (978) 688-954
a FAX (978) 688-954
�Aemus
TOWN OF NORTH ANDOVER
OFI'ICE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
COMPLAINT FOR INVESTIGATION
DATE: 6'_ f c) 3
FROM: y'1
ADDRESS:` 4 d XZti Lu � � G--4 / 1 . Tel #:
IT
Complaint Against: `T A LA,fi. RA dv Ave, �C n n d r3
ELECTRICAL:
PLUMBING:
GAS:
BUILDING CONTRACTOR -
PROPERTY OWNER:
PON Cf rak' �
o�.lu"e1", 15 c1%c V_ -,%.o N wyu�4or-s -.
Signed:
4r
m
DATE: a Q�
TOWN OF NORTH ANDOVER
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
- 27 Charles Street
COMPLAINT FOR INVESTIGATION
03
FROM • Pax ryl
ADDRESS: cwx. a4.-4- c=v-
—Yj . Cxt, dna-v-. C
Complaint Against: # �G A u� n q Q... `Pc, LJ I Co a n O rs
Telephone (978) 688-95z
FAX (978) 688-95z
ELECTRICAL:
PLUMBING:
GAS:
BUILDING CONTR""Aj��CTOR-
RROPERTY OWNER:
OTHER:
Signed:
0-Y1 �1*1