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Home My WebLink AboutMiscellaneous - 21 ALCOTT WAY 4/30/2018,�,�°�4 ��, �� '�� , 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with theprovisions ofM.01. c. 143,'§.3L, the \ permmit 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. GI c. 166, § 32, an electrical permit shall be issued to the person, fum or corporation stated on the permit application. Such entity shalt be responsible for the notification of completion of the work as required in M.G.L. e. 143, § 3L. Permits shalLbe limited as to the time oLongoing constiuctioa.activity, and maybe deemed_by-thesnspector_of_Wires abandoned_and-invalid-ifhe—. or she has determined that the aufho&ed 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 of2010 and extended by Sect ons.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 dxtends, forfour 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. [s 8—Permit/Date Closed: ❑ Permit Extension Act — Permit/Date Closed: *** Note: Reapply for new NORTp 1 0 SAC04US Date./o..3; .. .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatK ......... .......................................................... has permission to perform ...... wiring in the building of .......,..'y? ................................................................. at ... != .............. ............................... ... d('* .... North Andover, Mass. Fee 4.............. Lic. No.F-201..��P.............. Li ... Check # 464 4 .y Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No.�/ Occupancy and Fee Checked�c� { Zev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.01 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:/9 City or Town of: NORTH ANDOVER To the Inspector By this application the undersigned gives notice of his or her intention to perform the electrical, Location (Street & Number) �21 AL f 077 w,4v 'fres: described below. Owner or Tenant �7e im Eie a f // Telephone No, Owner's Address �51!n E t� Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No, of Meters No. of Meters Location and Nature of Proposed Electrical Work: hn%eliv n ® 4,44014 f �� -rct st4cc -e t"2. Cn/71/71Ptin/9 nfthv fnlinlVina fnhln 1-- hn ,—i—d by tl,, 1 .....•tar- nl*ld%ir— No. of Recessed Luminaires 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 ❑ n- ❑ rnd, rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Cas Burners No. of Detection and Initiating Devices No. of Ranges ota1Tons No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number I Tons I KW I No. of Self -Contained Detection/Alerting Devices !i No. of Dishwashers Space/Area Heating KW Local ❑ Municapa ❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems:* No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Si ns Ballasts Data Wiring: j No. of Deviles or Equivalent l No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: ;ltlach additional detail if desired, or cis required fry the Inspector of ll'ires. 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:) I certify, under th ai s agar penalties of' erjury, that the inforruation oil lis application is true [earl coraaplete. FIRM NAM, . /[s �/ RJU [w� LIC. NO.: Licensee: 3Ia%% 1(Ajt[v!.- Signatu e LIC. NO.: V;- (/%crpplicah e, en r "exect�, in the license nanibei line.)n�,,, Bus. Tel. No. '4� Address: �SoY (I 5 No plt�er nnt4 �(s Alt. Tel. No.�� -�K ' Per M.G.1, 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 Signature Telephone No. PERMIT FEE: $�p � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Indivi Address: /'.0. l (U City/State/Zip: NC) . fry'1tt OV15C - Phone #: Are you an employer? Check the appropriate box: LEI ❑ I an a employer with 4. ❑ I am a general contractor and 1 e ployees (full and/or part-time).* have hired the sub -contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised. their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling. 8. ❑ Demolition 9. ❑ Building addition 10: Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other -- —•-••--••� R „ ��, u,o secuun uelow snowing their workers' compensation policy information. +Homeowners who submit.tiris ai,ldavit indicating t1�eg are doa:g alt :�=ork attcI (hen hireoutside coniraciors 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 Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 4 Lsll✓ City/State/Zip: Attach a copy of the workers' compensation poi' 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 ceriffiv under � s n pengl * of perjury that the information provided above is true and correct Phone #: ?Sr t— S/S/-- 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 #: 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 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-contractor(s) 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 carr 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. Theaffidavit 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston., MA 02111 Tel. # 6I7-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 ww-w-mass.gov/dia r' E 1: NORTH Ot fO. A SACMU Date.... ............................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...!.!� �°� C �! N S'P ``" .................................................................. ,has permission to perform ... ''�' l-i�'� � C" ............................ ..................................... wiring in the building ofE?.r .. " ......................................................................... t [ Q(ev at ....... a .............. .............V... iZ:.....�................ , North Andover, Mass. FJ o-� Q411TEPIN't ELEcrmcM PECTOR Check # 55'14r 11W t,(JJM 1V1v yrrra s ,s n yr 11Vfn aarit.nv.usi i u -, DFp MMENl0FPUB[XS —' " Permit No. 3 / V -A'7) WARD0FMEPREVF1=NRW ,d M0NSSl7aAR&,W Occupancy & Fees Checked APPUCA77ON FOR PERMIT TO P ORM ELEcnuc4L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA HUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electtiil work d cribed below. Location (Street & Number) j C n (LG Owner or Tenant /jJa, -e-/( Owner's Address Is this permit in conjunction with a building permit: Yes [M No (Check Appropriate Box) Purpose of Building yP„p,<do & >✓ Utility Authorization No. Existing Service Amps�Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work W c ri A:8 i� aeQ No. of Lighting Outlets No. of Hot Tubs No. of Transfonnen Tata) KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA tend tend No. of Receptacle Outlets No. of Oil BurnersNo. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposal No. of Heat TOW Total Pumps Tons KW Initiating Devices No. of Sounding Devices -� >Y No. of Dishwasher Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal other No. of Dryer Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors TOW HP OTHER- 1;� aroeCoenagt: R»tbd�eregtioemaicdMt�ad>us�Gat®1La►�s Ihareakmilpdv&proofaf=w1odr0ffiae Y¢ WakioSw kop cimDaleAgrsted Sigt>edultd3 Pe>aldesofpajtxyr. !tel77 ��'�f' FEMNAME .wro 9 slat YES U NO LJ ffycuharedrdW YES, Pkmm&M dletypecfooW by 17 "=Sp *) (o FsWl lodValueofE1Mb cal Wodt $ F ted" LioaneNa Lio=No DJ E _ AM= � 7 AILTdNa OINMUS1[61RANMWAIVFR;Iama md>a drLimmdoesnothar dr axmwcovmvcritsaksmlwegiavdgas 4madbyNlmm fitsmCtnaWLam and drat my �tahae on dis �eart't appka6rn waiter dig taquit3rtalt (Please check one) Owner Agent a Telephone No. PERMrr FEE S Signature Owner r' 40RTH T 0 ,• p SS, NUSEt h Date .......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... �.. ............. ...... . has permission for gas installation ........... -�'-... . in the buildings of ?'?�"�-� ........................... at s!,!�.... ....... North Andover, Mass. Feer . !� ... Lic. No. !�.. �' ......... GAS INOR Check # 51127 MASSACHUSETTS UNIFORM ('Type or print) NORTH ANDOVER, MASSSACHUSETT Building Locations Owner's Name FOR PERMPT TO DO GAS FfIMNG Date (9 `` ` Permit # mount $' New ❑ Renovation ❑ Replacement ®'� Plans Submitted ❑ o 0 W x o a z z W H p A H " Z ,j 3 O ° O CA WO o 0 a SUB•BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print or tyK?� Name Address Check one: Certificate Installing Company f L, ❑ Corp. ❑ Partner. 11 usmess Telephone — , -7 —y3 9,,V / Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE 1 16VA Vllt . I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked yes, please i 'cate the type coverage by checking the appropriate box. ❑ Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the aeraus ana miormauu„ 1 ua— —, .-- -rr--------- __ .___ ____ best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuset oVe and Char 1 e11 Gener 1 ws. own (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber ❑ Gas Fitter tcense Number Master ❑ Journeyman V t Date. ;?.- l. 7-. . ?. 9 N' - '4684 0'.".O R' : -1 TOWN OF NORTH ANDOVER PERMIT FOR -PLUMBING '4cmus ' , /-/.This certifies that ?^. .0 . has permission to perform ... � * 7- ' plumbing in the buildings of e'. ............ at. . North Andover, Mass. -9 Fee. ./At. Lic. No.. .. ...... ...... * ....... PLUMBING INSPECTOR 07/22/99 13-24 15.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO LUMBING (Print or Type) Li 0)010eMass. Date Ib 1gq Permit # �D�y FORWARD Building Location Ak L . WCi � Owner's Name Type of Occupancy �� S New nqReplacement Plans Submitted: Yes ❑ No- MAP oMAPFIXTURE Installing Company Name MQ P. P(Q1,4 1 M6 + Ht4i� Check one: Certificate Address�K iCaR SI: S -Pau cLI L-A Corporation ❑ Partnership Business Telephone �I� [- ❑ Firm/Co. Name of Licensed Plumber Gk 602,V k �� 1 G INSURANCE COVERAGE: I have a current 'ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes IV No ❑ If you have cK&ked Les, please indicate the type coverage by checking -the appropriate box. A liability insurance policy �< Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations eppe�rf�oormed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum(`o de and Chapter 142 o e Gen I La s. By Signature ofLi used mber Title Type of License: Master Journ man ❑ City/Town � 0 0, q _ APPROVED (OFFICE USE ONLY) License Number ■��i��t��MEN Installing Company Name MQ P. P(Q1,4 1 M6 + Ht4i� Check one: Certificate Address�K iCaR SI: S -Pau cLI L-A Corporation ❑ Partnership Business Telephone �I� [- ❑ Firm/Co. Name of Licensed Plumber Gk 602,V k �� 1 G INSURANCE COVERAGE: I have a current 'ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes IV No ❑ If you have cK&ked Les, please indicate the type coverage by checking -the appropriate box. A liability insurance policy �< Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations eppe�rf�oormed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum(`o de and Chapter 142 o e Gen I La s. By Signature ofLi used mber Title Type of License: Master Journ man ❑ City/Town � 0 0, q _ APPROVED (OFFICE USE ONLY) License Number z 0 to m r Q -n O m 0 m m 0 m c N m 0 z r -c m p' m m z � Sivn o r, p p C 77 p i � z a m 3 � 0 v 0 r c z 0 to m r Q -n O m 0 m m 0 m c N m 0 z r -c