The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 196 CARLTON LANE 4/30/2018 / 196 CARLTON LANE 210/107.A-0205-0000.0 r � , V-IsI Date..... ...... ......`...l....... F NORT TOWN OF NORTH ANDOVER a PERMIT FOR WIRING 7 �+�ieo•�.�4 SSACMUS� This certifies that ..........4-Aa-4......A ................................................................. has permission to perform ..c,�. ...°..:..+ ✓le.�.. ....�.{ wa..,S�.n ?vo.M....`.......... wiring in the building of..... . „CGT.) G .), a,rl.....LPP&..4_PoNy?.f pS5 e, ................North Andover,Mass. Fee....!. b..........Lic. No.t 7Z3KA......../i. -�--- . ...................... ELECTRICAL INSPECTOR Check# r Commonwealth of Massachusetts Official Use Qft Department of Fire ServicesOccupanPermit No. Checked BOARD OF FIRE PREVENTION REGULATIONS j and FbW& APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wank to W performed in aecmiance with the Msssachusm Electrical Code Wf,%127 CMR 12.00 (PLEASE PRXTJ7V INK OR TYPE ALL INFORMATION) Date:_( City or Tom,of.. >> hd1R,v-r- To the Inspectok of lyres: By this application the undersigned gives notice of bis or her intention to perform the electrical wale described below. Location(Street do Nom) Wo O n Owner or Tenant 0 5 Telephone Na Owner's Address W-L Is this permit in conjunction with a building penult? Yes No ❑ (Check Appropriate Sox) Purpose of Building i � Utility Authorbation No. Existing Service '2,0 0 AmpsZ4� 1 Z'�l�V Overhead❑ Undgrd[Ef Na of Meters ,1 New Service _ Amps ! Volts Overhead❑ Undgrd❑ Na of Meters Number of Feeders sed Ampacity Location and Nature of Proposed Electrical Work: CIYt tQ V 4 . f00 Ano Compktm JkLolkwigtablemy be waived by do 1 of Wires. 1 Na of Recessed Luminaires Na of Ce"usp.(Paddle)FansNo.o formers Total No.of Luminaire Outlets Na of Hot Tubs Guars KVA 140.of CY"Pung Na of Luminaires Swimming Pool AboVe ❑ n- ❑ d. d. Ba Unit Na of Receptacle Outlets Na of OR Burners FIRE ALARMS Ne of Zees No.of Switches Na of Gas Burners No.Initiatim D Y°iees No.of Ranges No.of Air Cond. Total Tons Na of Alerting Devices No.of Waste Disposers HeatNTotanmlap am r � Detectlon/Alerthig Devices Na of Dishwashers Space/Am Heating KW Local❑ °A°ici ❑ (ther Na of Dryers Heating Appliances KW security Na of�or§gkoleat or of Waftr KW o.o o Duh er Heaters Ballasts Na of Mvices or Eaulvahat Na Hydromassage Bathtubs Na of Motors Total HP Na of or nivjLt OTHER: c/Yco) sub r .teach additional detail if desired or as required by the Inspector of ft es. Estimated Value of El cal Work: (When required by municipal policy) Work to Start: 5' 2 g $ ' Inspections to be requested in accordance with MEC Rule 18,and upon completion. INSURANCE C GE: 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"wverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit ism office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify,ander thepains mdputaftks ofpffp",that the hrfarnr den on this applicadon is trite and comptda FIRM NAME: LIC.NO.: 172-IRA Licensee: Richard J. Arel Signature 'LIC.NO.: 27514E (1fapplic4bk,enter'exempt"in the lieeme nmber fine.) Bn&TeL No.:978--372-1601 Address: Alt.TeL No.:WR-IM-21 R7 *Security System Contracror License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signsture below,I hereby waive this requirement. i am the(check one)[i owner�.nwnte s agent Owner/Agent PERMIT FEE:$ L Q Signature Telephone Na p a dJ V r � ,�flB CO,YIZIfZDIZIyE�Of lYlt�f�'!i'CIZIlf'E� � - DepaibiWnt of nd'As i1Acc d&.& . • - Office ofIre-Pestigations 6#0 Washington S&eet Boston,ItlA 02111 www.massgov/dia Workers'Compensation bunrance.Affidavit:i3uffders/Contrcactoirs/Electricians/.PlMnbers A.nylkant Womatica Please Pz nt Legibly Name(Business/OrgauriationllndwdaaD: zyr C .Address: City/State/Zip at '3 Phone Are you an employer?Check the appropriate box: Type of project(required): I.LEN am a employer with J 4• ❑I am a general contractor and T 6. ❑ ew construction employees(fill and/or part-time).� have bind the sub-contractors 2.El T am a sole pxoprietox or paxtnez listed on the attached sheet.T `1• Remodeling . ship and'have nonemployees Tbesesub-contractors have 8. ❑Demolition working for mean any capacity. workers'comp,insurance. 9• ❑Building addition PTO workers'comp.�asarance 5. ❑We are a corporajian and its 10•[]Electrical repairs or additions required.] officers have exercised.their 3.❑ 1 am a homeowner Aing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.Voworkers'comp. c.152,§1(4),anrlwehaveno 12.❑Roofrelsairs in�,,,�„cerecluiredj employees.[No workers' 13.❑Other comp.insurance required.] �yapphomt that dedm box#1 must also fill outt he section below sho&gtheirwbfte eompmsatioapolky information. (Homeowners who sabmitM affidavitiadioatingthl hire d9ing ailworlc and then biro outside conhwtors mustsubmit a new affidavit indleatiog suck tcontractors that cheek flib box must attached @a'ddditional sheet showingthe name of the sub.-contraotors and theirworkers'comp.policy information. I am an employer that is providing workers'compensatlon huuranee for gay eMloyees. Belov is the policy anct jots site infarrnatlora. - Insurance Company Name:. 7 '1 �d U &/1110 Policy#or ser-itis.no.#: 1416 A,7�G j Z 6 V6 ExpirationDate: �66- lob Site Address- A/P Q(�//4f�1 ��9J&'_/'. 4/State/4: Attach a copy ofthe workers'compensationlmolicy c'leclaration page(showing the policy number and expiration.crate). Failure to secure coverage as re�Luixedunder Section 25A ofMGL o.152 can lead to the imposition,of criminal penalties of a fine up to$1,500.00 and/or oneyear imprisonment,as well as cavil penalties in the form of a STOP WORTS ORDER and a fine of up to$250.00 a day against the vioktox Be advised that a copy of this statementmay be forwarded to the Office of Investigations of the DTA.for ansu ce coverage verification. ~ Ido Xiereby certify under theliairrs qndpenaftksaff erjur�r that file in,�'iirmadon providect'above is true and domed. si state: n /- ` .zsl1. T ate- Phone30Z- ercq_7 official use ody. Do not write In this area to be completed by city or town ofl elal. City or Town: PerniMicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/'fown Clerk 4.Electrical Inspector S.Plumtbing Inspector 6.Other - - Contact Person: Phone M Date... 4.113.............. OF NORTN,h TOWN OF NORTH ANDOVER O i p PERMIT FOR WIRING Mu 50 C, Thiscertifies that ...........................................................................c'.................:........................ has permission to perform ....�1.. N l�!c�� .............................................................................. wiring in the building of......... //r-S c� / ........................................................................................... at ..........42. �Ctn fv"� .A,............,....,N h Ando er,Mass. ............. .................... ....... �,[ �J Fee..:1.5 ..........Lic.No. ...... ..�............. . . ....... ... .. ........ /9 � ELECTRICAL�,`1SPEC:va Check# 1 v Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [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 ININK OR TYPE ALL INFORMATION) Date: 4&- 2, -lo/ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his ox her int ntion to perform the electrical work described below. Location(Street&Number). Owner or Tenant G h t Telephone No. k',;lS 3 Owner's Address �l'►�'" Is this permit in conjuncti n with a buil ing permit? Yes El No ® (Check Appropriate]Box) Purpose of Building jr)yit j t y Utility Authorization No. _ Existing Service C' Amps ( / )-HO 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: wj n'� jc&r l�e,r 'r Completion of thefollowing 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 ❑ In- El o mergency Lighting Z rnd. rnd. Batter Units p I lo. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Switches No.of Gas Burners No.of Detection and Initiatin Devices No. of Ranges No.of Air Cond. Total Tons No.of Alerting Devices 3 No. of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained n Totals: 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 KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent R No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: _ No.of Devices or Equivalent 1 OTHER: / .� Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of le trical Work: ! �1�G (When required by municipal policy.) Work to Start: 5� �'�J 3 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 9 BOND ❑ OTHER ❑ (Specify:) I certify,under the ains andpenaltiei.ofper* ry,that the information on this application is true and complete. FIRM NAME: . itt4/`I (; LIC.No.• //1,16 Licensee: amb Signature LIC.NO.: (If applicable,gaiter "e mpt"`in the lice number lime.) � j�J Bus.Tel.No. ?�''✓ r 0 Address: � _ tl L __3 (-tn Ct t&M ��/!rT C-, 0 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 PERMIT FEE: $716�77 Signature Telephone No. a � The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations qV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print UAW Name(Business/Organization/Individual): Address: 9_qn1*_s 60 City/State/Zip: Sq16M Iq if 7 0504 Phone#: q7& —y-L)" ^� 3 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. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X 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 workingfor me in an capacity. workers'comp.insurance. 9 y p ty E]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.El 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.❑Other comp.insurance required.] *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 a're 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:. 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 r 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 oOup 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 cer nder th pains nd p aloes ofperjury that the information provided above is true and correct. Si ature: Date: t't UZ 3 Phone#: CJ 7�'"• � 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#: Date i • yw�'TLHL,Ig�a'.. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .J7!- .!4-. ./. . c•�i.. . . . . . . . . . . . . . . . has permission for gas installation .r� . . . . . . . . . . . V� in the buildings of. a?b ss!. . . . at . North Andover Mass. Fee . . . . . . . . . Lic. No . . .4 . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check d 75-1�� 8801 �Q\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK f ..... CITY 90e'� w ! !!IUUI� P _; MA DATE� / � PERMIT# JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESSTE g7�1oY 3FAX TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT F EDUCATIONAL I RESIDENTIAL✓ CLEARLY NEW: .,,,, RENOVATION:,_r. REPLACEMENT: PLANS SUBMITTED: YES NO[ APPLIANCES 1 FLOORS BSM 1 2 3 1 4 5 6 7 8 9 1 10 11 12 13 14 BOILER ' i. I - I I BOOSTER ;: . F ... ...... E... ... d t .. .,i -..... CONVERSION BURNER . . COOK STOVE -_._ I _�.... DIRECT VENT HEATER --- --- DRYER g - _ .. d Yi 1 E d .4 FIREPLACE FRYOLATOR i- J- ft'- --Ar .... . .. ..... 1 i FURNACE GENERATOR �. ::: GRILLE i INFRARED HEATER .........._. LABORATORY COCKS ` £ MAKEUP AIR UNIT OVEN � —POOL HEATER HEATER . ROOM I SPACE HEATER ....... ROOF TOP UNIT TEST UNIT HEATER � ' �. ._._� . . ... .. r UNVENTED ROOM HEATER 9 WATER HEATER OTHER ? ( .... ... { .. .:::: i.... .. INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ENO n I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �'w,.l OTHER TYPE 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: NER ,,� AGENT a' SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true an a ra to h est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian th a P ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General_ Laws. PLUMBER-GASFITTER NAME Gre o W Stark Jr LICENSE# 11027 "1 f GNATURE MP . MGF 1 . JP JGF - LPGI j ..< CORPORATION I # 248tiC {PARTNERSHIP' #-� F. .. _._„._____�: �.�.�... �LLC:_. .#,....__ COMPANY NAME Stark&Cronk Plumbing&Heating � � ADDRESS 308 Main Street __._......_ CITY Grovefand -- - �. .. ; MA `ZIP 01834 TEL 978-372-6981 STATE FAX978 374-0837 CELL , REMAIL greg@starkcronk.com _ A,4V t The Commaweab ofMasswAwetts DePartment o I 1 �ttsfrial Accidents 001ce ofI rwWgdoons 600 Washington Street Boston,MA 02111 Workers'Compensation Insurance AfNa ers/Contractors/Electri A lira t information dmsiPlumben Name(sus; Stark&Cronk Plumbin Please L ' ness�Organizatiott!lndividuap: g Print bly Address: 308 Main Street City/State/Zip: Groveland,MA 01834 Phone#: 978.372.6881 Are you an emplayer?Check the appropriate box: 1.Q 1 am a employer with 10 4. 111 am a general contractor and I Type of Project(required): 2.[� employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction I am a sole proprietor or partner. listed on the attached sheet. ship and have no employees These sub-non 7• 13 Remodeling working for me in an Mors have y capacity. employees and have workers' 8' Q Demolition [No workers'comp.insurance come.insurance. 9. ❑ Building addition required.] 5. Cl We are a corporation and its 10.[]Electrical 3.❑ 1 am a homeowner doing all work officers have exercised their i 1`�Plumbing repairs or additions Myself [No workers'comp. right of exemption per MGL epairs or additions insurance required.]4 c. 152,§1(4),and we have no 12.[] Roof repair employees.[No workers' 13.gother 66US Pl n COMP.insurance required.] :Any applicant that checks box 01 must also fill out the section below showing their workers' Hontcavvnets who subma this affidavit indicating qW,att doing all work and then hire scow rn policy infoit anon. �Cbtttttsctors that check this box mut attached an additional sleet showiti the me co Am must submit a new affidavit indicating such employees. if the sub-cottttactors have provide their workets'oom su�t� and stue whether or not those entities have ��'�'must �.Polley number. Ww an orntatio �tint ss per ." Baer me formy eatlP&Yeft BdOw is tie pobky and/bb site Insurance Company Name, Peerless Insurance Co.,PO soot 507, Keene,NH 03431 Policy#or Self-ins.Lic.#: WC8319889 Expiration Date: 0 9/0 1/2 013_ Job site Address.J Cilo C'� _1 fL� �t�� city/State/zi :Il). .�r1C� Attach a copy of the workers'compensation Policy declaration p ` ()d Failure to secure coverage as POP(showing the policy number and expiration date} 8 required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 artd�or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to 5250.00 a day againstviolator. Be advised that a Investigations of the D f copy of this statement may be forwarded to the Office of coverage verification. :1debaYby cagyamtpaeallles ojper�irry tint tie >Mfo, ,oprios+�Tdeidabove is byre and correrx 09/01/201.3 none . 978-372-6981 t�'rcial rrse only. Do not write in this arra,a be cony eted by city or awn o fefal City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#' i w �J Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD PLUMBERS AND GASFITTERS IMPORTANT NOTICE PL LICENSED AS A JOURNEYMAN PLUMBER PERMITS FOR PLUMBING AND GAS FIT)R!G ISSUES THE ABOVE LICENSE TO: INSTALLATIONS ON STATE OWNED OR Ir5=D FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD.. TYPIE GREGORY W STARK JR -J 308 MAIN ST N GROVELAND MA 01834-1205 160703 21120 05/01/14 160703 LICENSE • . EXPIRATION DATE SERIAL NO. Fold,Then Detach Along All Perforations GENERATOR APPLICATION DATE: Sf I 1 13 LOCATION: IgLP CQLI`bT1 LO-r1- OWNERS NAME: bmnc, t �Oiq �OcSSI GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: Shut t G'OY11L PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: �ll.(��GVI � �1�✓� �V(,l� �IiVC-��w�) *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVA �L North Andover MIMAP August 1, 2013 - 5 x: ! , --•,fit.: �r�,3 �,.,� � ,�a 'r x .3, 1. ,� is t •E ♦ f�, y� ✓lca r� qsa r: f� 3 a a Interstates Interstate —Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack C,Easements f NORTH 9 Valley Planning Commission(MVPC)using data provided by the Town of North Andover.Additional data provided by the Executive Once of ❑MVPC Boundary �e'' X6'6�� Environmental AHairs/MassGIS.The information depicted on this map is Parcels .it' L for planning purposes only.It may not be adequate for legal boundary Fo definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING # r► THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT #0 �r �� ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF �1 o�„•�u��"�sj THIS INFORMATION ,SS�G►iU`�� 1"=184ft ��°