HomeMy WebLinkAboutMiscellaneous - 20 Redgate Laner -
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that........................................................................................ .....
has permission to perform ....�? C..... L� ..
wiring in the building of ........... 47-2 �.G-i/9 nxn"'
........ ............................. .................
at .........?:. .. ! ........ 1-.... .... , North Andovet, Mass.
Fee....IS... ''.. Lic. No. �y5,� /1.......... ....
!nbG! �. ELECTRICAL INSPECTOR/
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_ CJaParfmare� o� }ira i�niicse Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev. I/07J 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 PRIJVT IN INK OR TYPE ALL INFORMATION) Date: 1�) 1 �, t ( / rl
City or Town of: �(/ , gyp 00 Zo f ` To the Inspector of Wires:
By this application the undersigned gives notice of is or her intention to perform the electrical work described below.
Location (Street & Number) �O P� _,X ^ -,IL.0 % All
Owner'or Tenant
Owner's Address
Telephone Nlf. �(j tV
Is this permit in conjunction with a building permit? Yes ❑ No
Purpose of Building g] (Check Appropriate Boz)
Utility Authorization Nn_
Existing Service
t
New Service
Amps - / Volts
Amps / Volts
E Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Overhead ❑ Undgrd ❑ No. of Meters
Overhead Undgrd E:1 No. of Meters
No, of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
vy sire ins eC[Or of ►YIreS.
NO. of _Total_
KVA
No. of Luminaire Outlets
No. of Hot Tubs
SwimmingPool Above � n-
Generators KVA
❑ o. o Emergency tg Ung
No. of Luminaires
Ernd. rnd.
Battery Units
No. of Receptacle Outlets
No: of Oil Burners
FIRE ALARMS
No. of Zones
No. ofSwitche_c
No. of Gas Burners
No. of Detection. and
Initia#in Devices
_
No. of Ranges
No. of Air Cond. TorTons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump INumber Tons
KW
o. of Self -Contained
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipals
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of WHeaters KW ater
No. of No. of
Signs Ballasts
No. of Devices or Equivalent
Data Wiring:
No. of Devices or E uivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
elecommunications irino:
No. of Devices or E uivalent
OTHER: jnl�— oZ-% ��� _
Attach additional detail if desireg or as required by the Inspector of Wires.
Estimated Value of Electrical Work _'DQ -- - (When required by municipal policy.)
Work to Start: a 5 1"e 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 Q OTHER ❑ (Spcci.y:)
I certify, under the pains and penalties ofpedury, that LhTtKormadon on this application is true and complete.
FIRM NAME: 'P � Se�Cs�t'i Se LIC. NO.: C Z15�
11
Licensee: Q C'e, P_ t' Q Signattir� LIC. NO.: C
IVapplicab/e, enter "exem t" in the license number e , t Bus. Tel. No., 4
Address: 0-t-,ltrr, c30 Alt. Tel. No.
*Per M:G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" e: Lic. No. Do 953
OWNER'S INSURANCE WAIVER:. I am aware that the Licensee does not have the liability insurance covetage 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. S
_lam,•
Department of F
one .Ashburton Pt . ebltC Safety
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Boston, Ma �D11 O -I 301
Li'censc: S•Lir_Nnse
Number: SSCC- 000053
Expires:02/0712bx
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NORWOOD, MA 02062
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COMMONWEALTH -OF MASSACHUSETTS
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DOARD OFELECTRIC'AN5.
F REG;S•TtR-P) SYSTEM CONTRACTOR
15SUES Ull LICENSE TO
TY -E Alli�AE.CUFITY SERVICES;'IHC.
-NARK A %BE OPHY • SR.� t
-C iII.'M0RSE. ST
HORWOOD HA 020'62-4602' -
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number ? 19(6/22/2009) Date: March 15, 2010
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 20 Rednb-, Lane
MAY BE OCCUPIED AS Single Family Dwellin_
ACCORDANCE WITH THE PROVISIONS OF THE MASSAC]
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
IN
STATE BUILDING
Certificate Issued to: Whispering Pines Realty
4 Sandlewood Lane
Methuen MA 01844
Building Inspector
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9
APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION
Building Permit # %l
ADDRESS/LOCATION OF PROPERTY: CZC�
Map Parcel e-' cj Lot Number
SUBDIVISION
DATE REQUESTED FILED/READY FOR INSPECTION A�lr. in, -1 /C)
CLOSING DATE ON PROPERTY: %''• , c,, j,,, -/, i s�
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE Coms
Pennit Issued to: ./,`s
Address '� ,�'. �1S
SIGNED
CONSERVATION
PLANNING
DPW - WATER METER
SEWER/WATER CONNECTION
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
Signature
File: Application for OC form revised Jan 2007
v
Date..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .....'.:.,! .?-c.........: ..........
has permission to perform ...,.... .. ..
...........................................
wiring in the building of..
atc'l°...::..........�. 4�L .:....�-................................. . . North Andover, Mass.
Fee'f/.� Lic. No.F-3Q.?,l 1`1 ................... .,
CTRICZ INSPECTOR
Check #
•
Q Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use
Only
Permit No. d"/al7f
Occupancy and Fee Checked ,_� S2-
[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), 5,27 CMR 12.00
(PLEASE PRINTININKOR TYPE ALL INFORMATION) Dater 3
City or Town of: NORTH ANDOVER To the Inspecto of Wlres:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Q l" j re_p,( /—A L_ )
Owner or Tenant }�. r
Owner's Address
Telephone N G
Is this permit in conjunction with a building permit? Yes No FE -11 (Check Appropriate Box)
Purpose of Building�)� Utility Authorization No. ►'7 »� h Q
Existing Service Amps / Volts Overhead ❑
New Service (t&D Amps / olts Overhead ❑
Number of Feeders and.Ampacity ,✓ v-,--?
Location and Nature of Proposed Elec rical Work:
Undgrd ❑ No. ofMeters
Undgrd No. of Meters /
Completion Of the ollowin table may be waived b the Ins ector o Wires.
No. of Recessed Luminaires
No. of Luminaire Outlets
No. of Ceil: Susp. (Paddle) Fans
No. of Hot Tubs
No. of Total
Transformers KVA
Generators KVA
-
No. of Luminaires
No. of Receptacle Outlets
Swimming Pool Above ❑ In-
d• rnd.
No. of Oil Burners
❑
o. o mergency ig g
Batte Units
FIRE ALARMS
NoLd of ?ones
"
No. of Switches
No. of Ranges
No. of Gas Burners
No. of Air Cond. TonTotTots
No. of Detection
Initiatin De
No. of Alerting D
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
No. of Water
Heaters'
No. Hydromassage Bathtubs
_ _
Heat Pump Number Tons KW
Totals:
Space/Area Heating KW
Heating Appliances KW
_N0-_0 f
SNo. of
i s Ballasts
No. of Motors Total HP
No. of eif-Cont
Detection/Alerim
Local ❑ Munici
Connec
Security Systems:
No. of Devices or Equivalent
Data Wiring:
No. of Devices or E uivalent
Telecommunications Wiring:
No. of Devices nr Fnivivnl.,..+
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 co rage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify, under the aims and Pena ties of perjury, that the information on this application is true and complete.
FIRM NAME• LIC. NO.:
Licensee: J; �� / '� �� Signature f--- LIC. NO.:
(If applicab e, enter "exempt " in the license number line)
Address: Bus. Tel.1
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt. TelLic. 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 flus requirement. I am the (check one) ❑owner ❑owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE: $02
-10
The Commonwealth of Massachusetts
na
Department of Industrial Accidents
"4 Office of Investigations
glsi,600 Washington Street
iBoston, MA 02111
t' ; www.mass gov/dia .
Workers' Compensation Imiwanee Affidavit: Builders/Contractors/Electricians/Plumbers
A�nlicant Information Please Print Legibly
Name (Business/Organirationlindividual):__ Imo!
Address: c7J 7s (-T- J-)) S 1 /741.,, /1 _ i
city/state/zip: �� � � Q
�y (��/ /�iTl Phone #:_.
Li,�rou
t3.tn a employer with � 4. Q 1 am a genera( contractor and I
Aran employer? Cheek.the appropriate box:Fe
"ect r ni1 (eq red):
employees (full and/or part-time).*
2. (] I am.a.sole proprietor or partner_
have hired the sub -contractors
listed on the attached sheet. I
construction
deling
ship and have no employees
These sub -contractors have
.(�Demolition
working for me .in any capacity,
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
g, Q Building addition
required.]
3. ❑ I ain a homeowner doing
officers have exercised their
10•0 Electrical repairs or additions
all work
right of exemption per MGL
I I.Q Plumbing repairs or additions
myself. [No -workers' comp,
C. 1.52, § 1(4), and we have no
12. ❑Roof
repairsinsurance
required.] t
employees. [No workers'
13.❑.Other
comp. insurance required.]
rr•• •••• •• �• w•� ��x rr musc a�so nu out the section below showing their workers' compensation policy information,
t Homeowners who submit this affidavit indicating they are doing all work and then hie outside contractors must submit a new affidavit indicating such.
4contmators that check this box must attached an additional sheat showing the name of the sub -contractors and their workers' comp. policy infonnation.
I am an employer that is.provMing workers' compensation insurancefor my employees; Below is the policy and job site
information. , , ;
Insurance Company Name:
------------------
Policy # or Self -ins. __11Lic. #: C2��717 Expiration Date: C>l
Job Site Address_ `y C) 4,
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 andpenalties ofperjury that the information provided above is true and correct
Sienature: Date:
Phone #:
rrOfficial 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 Cierk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: 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 ismance 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 of public 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) aind 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 numberlisted 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 permittlicense number which %,ilI be used as a reference number. In addition, an applicant
that must submit multiple permitflicense 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 bum 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
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-&.77-MASSAFE
Fax # 617-727-7744
Revised 5-26-05 VAM.Mass.gov/dia.
JA MES A. O'DA Y. P. E.
599 Canal Street
Lawrence, MA 01840-1233
Richard Keller
4 Fosters Pond Road
Andover, MA 01810
Re. 20 Red Gate Lane, North Andover
To whom it may concern,
Office: (978) 687-6350
Res: (978) 373-4395
October 13,2009
On October 13, 2009 t inspected the house under construction at the above referenced
address. I found that the structure was in accordance with the plans. I did find however that
two locations on the first floor requires blocking between the columns and the first floor. The
locations are below the columns for the first floor windows and the garage beams the second
is at the column in the rear of the cellar.
Should you have any questions please call me.
Very truly yours,
)James A. O'Day P.E. JAMESALFR� tiN