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Home My WebLink AboutMiscellaneous - 1857 GREAT POND ROAD 4/30/20189656 Date......... ....................... °.<"`° TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... me... .b ..... 7— ................................................................... has permission to perform ......... ......................................... wiring in the building of........... .................................................... 7 - 9' at ........ &–t . e- -- t�- 0 North Andover, Mass. ........................................... ...................... Fee ... Lic. No..... 9'��6e4 ............;2'?7 . ..... LEcrRICAL INSPECTOR Check # 3-86 7 -� a.vrrrrravaawt:aaaaa Ua n�s�a��sa�,Aaae��aa� --- - - l- _ Permit No. S✓` Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) M APPLICATION. FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: % —/ %- AC - 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) kJ -7 J:?1UA PnA(f Owner or Tenant /z(Git r - Telephone No. Owner's Address 4�,- 5 /t U'2:t7,4 7 Is this permit in conjunction with a building permit? Purpose of Building Existing Service ZqZ Amps Volts New Service Amps / Volts Yes ❑ No K (Check Appropriate Box) Utility Authorization No. Overhead Fd Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C'mmnletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: (Paddle) Fans v . Total TransSusp. Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ g rnd. rnd. o. oUnits Emergency Lighting Satter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection andInitiating No. of Switches No. of Gas Burners Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers P Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW S P g Local El ❑Other Connection No. of Dryers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of WaterNo. KW of ' No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ��-r i/ F DN -Attach additional detail if desired, or egzured 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:) Y certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: W 6 I F 071 --,tee NC (� f ' LE LIC. NO.: e2j�UC� Licensee.`®-I_w1 Nua-"Vw Signature LIC. NO.: a3 6 GU (If applicable, enter "exempt" in the license number lined.,_Bus. Tel. No.: Address: -4 0 Alt. Tel. No.:Syf- 3Z,6 *Per M.G.L c. 147, s. 57-61, security work requires Department j6f Public Safety "S" License: Lie. 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. i�zy'/U ss �v � �� -f /� � ��` vv�. �4 J /�- � .� r,er' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 19 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �-6 P lh; cC o20 City/State/Zip: c� Phone Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11. E] Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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. Below is the policy and job site information. Insurance Company Name:1DZA:,UFr Policy # or Self -ins. Lic. L_00 ��, ` �ation Date: Job Site Address: (''1�£iG4� �Nb fZC�� 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 may be 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. Signature: Date: `l 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 #: Are u an employer? Check the appropriate box: 1. I am a employer with_ 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. # �d 2. ❑ 1 am a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11. E] Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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. Below is the policy and job site information. Insurance Company Name:1DZA:,UFr Policy # or Self -ins. Lic. L_00 ��, ` �ation Date: Job Site Address: (''1�£iG4� �Nb fZC�� 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 may be 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. Signature: Date: `l 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 #: W Date ..... TOWN OF NORTH ANDOVER PERMIT 'FOR WIRING T 3-epo This certifies that ............ sion 7- ........... ............................ has permission to perform ............................................................................... wiring in the building of ................ .0 .................................... A at ......... ................. ......... ..... North Andover, ass. Fee .... Lic. No. .......... '61crRICAL INSPEC*Tgi Check # 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 tVrovide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed r on the prescribed fomi. After a permit application has been accepted by an_Insgeet5r of Wires appointed pursuant to M. GI 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 ofongoing construction activity, and may be.deemed-by. the,Inspector_of Wires abandoned-and.invalidif 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 puipose 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. Rule 8 — Permit/Date Closed: _ �.! * * ote: Reapply for new permit E. 0 Permit Extension Act — Permit/Date Closed: NERREMMM Cointnonwealtk of Maddackudeth 2apad ted o/3ire Serviced BOARD OF FIRE PREVENTION REGULATIONS, Official Use �Only Permit No. f -/ Occupancy and Fee Checked [Rev. 1/071 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: / O 22,5 Ja City or Town of: /Ja rA ,4 t it o e_r-- To theI p ce for of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) j 8�`7 . GreA�ovtd r Owner or Tenant-��! e , �� 1 r O Telephone No. Owner's Address J0.Vy, Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building W e, vt;G Utility Authorization No. . Existing Service /00 Amps /Zo/ Z4!o 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: Paz! c�n. No.. of Recessed Luminaires -- - No. of Ceil: Susp. (Paddle) Fans vc nus vfu uY use isw euur u rr tres. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. nd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches a No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number -` Tons KW '" No. of Self -Contained Dete!cIttion/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Other Connection No. of Dryers No. of Water Heating Appliances KJ NO.KW No. S� s Ballasts Security ystems: No, of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. -of Motors Total HP Telecommunications Wiring: No. of Devices or EQ uivalent OTHER: nisch aaamonat detail ij 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 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 (9 BOND ❑ OTHER ❑ (Specify:) I certify, under the of s andpenaltieslofperju�i, that the information on this application is true and complete. FIRM NAME: 2 . Pr-}- �e��t-�.6 L I 2 �a LIC. NO.: /g2 9 I A Licensee:�g �, �e-�e Signatur LIC. NO.: 5 (Ifopplicable, enter "exempt" in the license number ine.) Bus. Tel. No.: ,% c1- 6$�' Address: kue. Pzr A OLR G6 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires apartment 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 Signature Telephone No. PERMIT FEE: $ � ro-�2 �- � V�� 4902 • Town of North Andover M�'��:;;>:• �� HEALTH DEPARTMENT ,SS�CNUSt� CHECK #: D TE: / LOCATION: AV�4'`C",U'• H/O NAME: CONTRACTOR NAME: Type of Permit or License: (�e) box) $ ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ m.16ther: (Indicate)G?�'%/I (9��-�-- $%G� I Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer a TOWN OF NORTH ANDOVER NORTH ANDOVER, MASSACHUSETTS 41845 Permit Number /1/' oM0/0 Date Issued /% `O Expiration Daie Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant "e Phone Cell Street Address 1 q 3 WASH w6rpn ST City/Towq MA ZIP( U�1-2 B Name of Excavator (if different from applicant) Phone Cell Street Address SAW �M City/Town MA ZIP Name of Owner(s) of Property Phone Cell Street Address l S7 68riAl- Pm6 AD City/Town MA ZIP Motu ANUovt I Other Contact Permit Fee Received No Yes Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if additional space is needed. TC-fi Ptrs F01'\ ROOK PAAsn SVsrrrw. /0-7-10 Tp,Ktk5 fbkor Insurance Certificate #: z s,, Name and Contact Information of Insurer: Policy Expiration Date: Dig Safe #: '7010 y/o 163"t Name of Competent Person (as defined by 520 CMR 7.02): J AA, 8vrt- oSA `ohr Massachusetts Hoisting License # H6 ' ,/ j /q Z �-`a - Last License Grade: IC 2. A Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c. $2A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. 21Page DATE / 6) —/ -d (IF DIFFERENT) DATE /0-6-10 'S SIGNATURE (IF DIFFERENT) DATE: CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application, the applicant understands and agrees to comply with the following: ff 0 iv. V. No trench may.be excavated unless the requirements of sections 40 through 40D of chapter 82, and any accompanying regulations, have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including, but not limited to, the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164 (DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section i of Chapter 82 of the General Laws, an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may inolude covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR 1926.650 et.seq., entitled Subpart P "Excavations". Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; By applying for, accepting and signing this permit, the applicant hereby attests to the following: (1) that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2) that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CMR 1926.650 et.seq., entitled Subpart P `Txcavations" as well as any other excavation requirements established by this municipality; and (3) that he is aware of and has, with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application, complied with the requirements of sections 40- 40D of chapter 82A. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www.massgoy/dns 31Page Summary of Excavation and Trench SafetX Regulation -020 -CMR 14.00 et seq.) This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L.c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A, go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety, jointly with the Division of Occupational Safety, drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction -related purpose on public or private land or rights-of-way. All municipalities must establish a local permitting authority for the purpose of issuing permits for trenches within their municipality. Trenches on land owned or controlled by a public (state) agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators, whether public or private, take specific precautions to protect the general public and prevent unauthorized access to unattended trenches. Accordingly, unattended trenches must be covered, barricaded or backfilled. Covers must be road plates at least V thick or equivalent; barricades must be fences at least 6' high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times, for instance by hiring a police detail, security guard or other attendant who will be present during times when the trench will be unattended by the excavator. The regulations further provide that local permitting authorities, the Department of Public Safety, or the Division of Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury; the failure to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The trench shall remain shutdown until re -inspected and authorized to re -open provided, however, the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of Public Safety for identified violations. Summary of 1926 CFR Subpart P -OSHA Excavation Standard This is a worker protection standard, and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational purposes only and does not constitute an official interpretation by OSHA of their regulations, and may not include all aspects of the standard. For further information or a full copy of the standard go to www.osha.sov. Trench Definition per the OSHA standard: o An excavation made below the surface of the ground, narrow in relation to its Iength. o In general, the depth is greater than the width, but the width of the trench is not greater than fifteen feet. s Protective Systems to prevent soil wall collapse are always required in trenches deeper than 5', and are also required in trenches less than 5' deep when the competent person determines that a hazard exists. Protection options include: o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices, the equipment manufacturer's tabulated data, or designed by a registered professional engineer. o Shielding (Trench Boxes). Trench boxes must be used in accordance with the equipment manufacturer's tabulated data, or a registered professional engineer. o Sloping or Benching. In Type C soils (what is most typically encountered) the excavation must extend horizontally 1 %2 feet for every foot of trench depth on both sides, I foot for Type B soils, and % foot for Type A soils. o A registered professional engineer must design protective systems for all excavations greater than 20' in depth. continued 4 1 P a g e • Ladders must be used in trenches deeper than 4'. o Ladders must be inside the trench with workers at all times, and located within 25' of unobs lateral travel for every worker in the trench. o Ladders must extend 3' above the top of the trench so workers can safely get onto and off o ladder. • Inspections of every trench worksite are required: o Prior to the start of each shift, and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person (see below). • Competent Person(s) is: o Capable (i.e., trained and knowledgeable) in identifying existing and predictable hazards in the trench, and other working conditions which may pose a hazard to workers, and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation (e.g., contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected, supported, or removed once exposed. Spoils must be kept back a minimum of 2' from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. • Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench, they must be underpinned, braced, or otherwise supported. o Sidewalks, pavements, etc. shall not be undermined unless a support system or other method of protection is provided. • Protection from water accumulation hazards: o It is not allowable for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation, this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water, ditches, dikes or other means must be used to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench, a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath loads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high -visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4' if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist (e.g., Oz <19.5% or >23.5%, 20% LEL, specific chemical hazard), adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches > 6' deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. 5 1 P a g e FROM NEVE-MORIN GROUP 97� (bb aq 7G (THU)SEP 30 2010 9 F Auth4tr ttAu Form Re: 1857 Great. Pond Roa , North Andgver T, Stephen Galizio, authprize The NcvG Moria, Group to sign an the Town of North Andoucr otl my be laIf j gdroing the above -rel Stephen alizio 0%l 10 Date P 2010-09-3010:32 9788873480 Page 2 10/06/2010 08:16 9783733360 BJ KITTREDGE I PAGE 01 A CERTIFICATE OF LIABILITY INSURANCE DATE(M THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTiFICATIs HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT DETWEEN THE iSSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. fMPpRT NT: M the certificate holder is an ADDITI AL INS ED, fhe policy(les) must be 8ndorsed, If SUBRQGA N I$ WAI D, augJact to the terms and conditions of the po11Cy, certain policies may esquire an endorsement. A statement on thiscertlficate does not Confer rights to the certificate holder in lieu Of such endOrsamenfiII PRODUCER — Barry Li. Kittredge ins Agency 81 South Main Street PO Bax 5206 Bradford, MA 01835 _.... ............ _........ INSURED ---- John Butt dba JB Northshore Construction 143 WeLshington St. Boxford, MA, 01921 (978) 373-3360 _. IN9URE S AFFORDING COVERAGE _ NAIC N !...). _. NSURERA:Merchant9 Mi tiisrl INSURER D: COVERAC3ES I NOURER F— CERTIFICgTENUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE uSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANpNNG ANY REdUlREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEFiT1FlCATE MAY E3E ISSUED OR MAY PERTANv, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CY R TYPEOPINSURANCE tILICYEFF POUCiY GENERAL LIABILITY M/DD/V MM/DD LIMITS A XCOMMERCIAL GENERAL LIABILITY GLP91066$2 EACH OCCURRENCE I....._39_010_00 I 8�14�1A 8�14�11 AM4GETOEp _ CLAIMS -MADE OCCUR j 1 $_ 100,,(Q00 MED EW (grryone Persm) — 5 &1009 I PERSON4LBADVINJURY t 9AA Ann GEN'L AGGREGATE LIMIT APPLIES PER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Health Department S KU UNrC.A Ir $ — F7 PRO- POLICYF7 North Andover, MA 01845 PRODUCTS -COMP/OP AGO $ --- X= L AUTOMOBILE LIABILITY $ — ' COMBINED SINGLE LIMIT _ ANYAUTO (Ea accident) $ ALLOWNED AUTOS BODILY INJURY — Y (Par Deleon) $ SCHEOULEDAUTOS BODILYINJURY (Par w0denq $ HIREDALITOS PROPERTYDAMAGE $ (Per accident) NON -OWNED AUTOS UMBRELLA LIAB OCCUR EXCESSLIA15 EACH,OCCURRENCE $ CLAIMS MADE AGG RE GATS DEDUCTIBLE WORKERS COMPENSATION_ MID EMPLOYERS LIABILITY WC STATUTORY i - FQ ANY PROPRIEIDR/PARTNERIE�CUTIVE Y 1 N _.. OPPIOERWEM13EREXCLUDED? NIA E.L.El1CHACCIDENf $ IMAfWebry in and E.L. DISEASE -EA EMPLOYEES It yes, dea0rlba antler _... _ DESCRIPTION OF OPERATIONS below E.L.1DISEASE -POLICY LIMIT , $ DESCMPT10N OF OPERATIONS I LOCATIONS I VEW CLES IAVwh ACORD 101, AddiNenel Rarmrks Schedule, i1 more space la re4a red) CERTIFICATE HOLDER r. AILVICI r ATrAu 0 WN1 78rJU-WUUI► AI:UH:D UUKPOR�}pN. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD f// SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Health Department 1600 Osgood Street AU -MO n,rATIVE North Andover, MA 01845 0 WN1 78rJU-WUUI► AI:UH:D UUKPOR�}pN. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD f// Leathe, Brian From: Rick Gauthier [rg@gauthierconstruction.com] Sent: Wednesday, December 01, 2010 6:06 PM To: Leathe, Brian Subject: 1857 Great pond rd. Hi Brian , at your earliest convenience could you please remove 4 cense numbers and insuraince certificates from Gauthier Construction for permits regarding the Galizio resid ce at 1857 great pond rd. Th nk you Rick Gauthier 978- 509-4049 Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: ham://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1