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Home My WebLink AboutMiscellaneous - 200 VEST WAY 4/30/2018JOSEPHN/F COUFDI S CONTRADA L=64.50' ' 90.00' N83'09'26 R=1276.73' VEST c50' WiDE>WAY SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS MAP #104D BLOCK # 105 SUBDIVISION LOT #56. SEE E.N.D.R.D. BOOK #2649 PAGE #236 FOR SITE DEED. WETLAND FLAGGED BY NORSE ENVIRONMENTAL TYNGSBORO, MA 9/26/12 1013112 STEPHEN E. STAPINSKI, R.L.S. DATE PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR DALE LEWIS 200 VEST WAY NORTH ANDOVER, MASSACHUSETTS SCALE: 1"=60' DATE: OCTOBER 3, 2012 II WRIWACK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 S80'20'47"E -- 2 STORY W.F.D. 212.00' POO elm' 8A ` eD l� N w `I 1 PROPOSED 7A rn - io Lo Ln e ENTRANCE ' IA ul GA O N 2A JA AA N �lf�/OT X56 _ - AREA=/3,794 S.F. -= —1.0054 AC. I�I EIOSRND L=64.50' ' 90.00' N83'09'26 R=1276.73' VEST c50' WiDE>WAY SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS MAP #104D BLOCK # 105 SUBDIVISION LOT #56. SEE E.N.D.R.D. BOOK #2649 PAGE #236 FOR SITE DEED. WETLAND FLAGGED BY NORSE ENVIRONMENTAL TYNGSBORO, MA 9/26/12 1013112 STEPHEN E. STAPINSKI, R.L.S. DATE PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR DALE LEWIS 200 VEST WAY NORTH ANDOVER, MASSACHUSETTS SCALE: 1"=60' DATE: OCTOBER 3, 2012 II WRIWACK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 e...- E70Rf�i0 2 STORY W.F.D. POO elm' eD l� N w PROPOSED 1 STORY rn - io Lo Ln e ENTRANCE L=64.50' ' 90.00' N83'09'26 R=1276.73' VEST c50' WiDE>WAY SITE IS SHOWN ON TOWN OF NORTH ANDOVER ASSESSORS MAP #104D BLOCK # 105 SUBDIVISION LOT #56. SEE E.N.D.R.D. BOOK #2649 PAGE #236 FOR SITE DEED. WETLAND FLAGGED BY NORSE ENVIRONMENTAL TYNGSBORO, MA 9/26/12 1013112 STEPHEN E. STAPINSKI, R.L.S. DATE PLAN OF LAND IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR DALE LEWIS 200 VEST WAY NORTH ANDOVER, MASSACHUSETTS SCALE: 1"=60' DATE: OCTOBER 3, 2012 II WRIWACK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 Date ... ZI z ° y.�......... TOWN OF NORTH ANDOVER This certifies that�� PERMIT FOR WIRING zCCA -41 /t IN4% ............................................................................................................................ has permission to perform ..'xP2,......... �► (f-ir�¢r Che.. wiring in the building of.. ... i 5........................................................................... st....Z-C�O �PS-........................................ North Andover, Mass. ..................................... Fee........... Lic. No. ................. ... V .... ..... ^ EL CAL SPECTOR -i Check#-(J/��/j - Existing Service / Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters \ Commonwealth of Massachusetts Official Use On�r Department of Fire Services Permit No. Occupancy and Fee Checked ` BOARD OF FIRE PREVENTION REGULATIONS [Rev -1/071 (leaveblank 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 ININK OR TYPE ALL INFORMATION) Date: 2- 2-4- - / 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) `gob V -eS -r jji/A � Owner or Tenant.L< Ly S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Ys Q' No ❑ (Check Appropriate Box) Purpose of Building %2P/— Utility Authorization No. Amps Volts No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4;v//Z �C,� O%C t f 1 Olr .S 714 /l � Y'-�P �i CJ � y G. - f Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires �j No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency Lighting Batter Units No. of Receptacle Outlets % No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burgers No. of Detection and Initiatin Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number *"***'**""****"'**'*"'I"** -......."** Tons 1.9W No. of Self -Contained Detection/Alertin Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security o Devices or Equivalent No. of Water KW Heaters No. 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 Equivalent FTHER: IQ 3 �� Attach additional detail if desired, or as required by the Inspector of fares. Value of Electrical Work: * /-57- Estimated 0 (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:),,,, re -d' r refs( I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. 2c� 1��2� C eve LIC. NO.: b t '2o� Licensee: _�'r'�� Gif ��f Signature LIC. NO.: (If applicable, enter "exempt" in t e license number line. ,/ Bus. Tel. No.:� l Address: � i� e- 1&�� /V A 6/ Vol Alt. Tel. No.: *Per M.G.L c. 147, s. -61, security work requires Department of Public Safety "S" License: Lic. No. � . /7V 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: $ Signature Telephone No. ❑ 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. -1 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 notification of completion of the work as required in M.G.L. c. 143, § 3L. 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 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. D. Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: f Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass [N Failed Re- Inspection Required ($.) ❑ Inspectors Comments: ZY .--i. Inspectors Signature: Date: FINAL INCTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: a-11" /�. S"z R Date: J--/ DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com ru The Commonwealth of Massachusetts Department of IndustriqlAccWnts Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance .Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): `deet-e✓G[i l�G IC <a z Address: i S y t City/State/Zip :�i!%'�� " �t GY�f// Phone #• '; 7 Are you an employer? Check the appropriate box: 1. EIJ a-a—employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working forme in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ❑ I am a homeowner doing all work right of exemption per MGL .3. myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. tiling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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 are doing all work and then.hire outside contractors must submit anew 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 anal job site information. Insurance Company Name:. / , �y e (e/- 5 Policy # or Self -ins. Lie. #:611�9 61 f ��5� r Expiration Date: Jam- Z3 fob Site Address: 0___G { 5 '¢ " " AA1eeZTq 1k— City/State/Zip: Attach a copy of the workers' compensatio 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certand the) 'ns and penalties of perjury that the information provided above is true and correct. Si ature: A 9 AJV11 Date: 6 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. PIumbing 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 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 maybe 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 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: `z'he Commonwalth. of Massachusetts DepartJaamt of Industrial Accidents Ofriee ofIuvestigatiom 600 Washington. Street Boston, MA 02111 TO, # 617-727-4900 ext 406 or 1.-877r ASS.A.]FE Revised 5-26-05 Fax # 617-727-7749 wWw-Mass.govaa. r