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Home My WebLink AboutMiscellaneous - 22 BUCKINGHAM ROAD 4/30/2018N Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... . ...... P1. ............................... ...... .. ................. has permission to perform ...... .. . ..... wiring in the building of ................. ......................................... 2 - at ............................ . . ..... North Andover, Mass. Fee..�:� Lic. No. .5.40 3.L . ......... ........ . r4`� . .. ...... .. RI� ELECT INSPECTOR Check, 0 y (fommonwealth of Mamac4ajelb 2eparlm,nt o/,}ire Service4 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/07] (leave blank) "APPLICATION FOR PERM T TO PERFORM ELECTRICAL WORK All work to be performed in accordance;vdl -.the Massachusetts Electrical Code (MEC); -527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Q� <- a City or To7pL! f 2 Touch inPector 01 as -"=rljt tlii application the utriiersigned gives notice chis or lerintention to erfbrm tiie elect`ncal work described below. Location (Street & Number) ,,/5,,� t;.t Owner or Tenant (`e d e I-j�G(,�—Lbs Owner's Address 3 j�ytt e.SL,i„ry Ny Telephone No. 52Y Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building &Vt4 4,1 r6 Utili Authorization NolA 3 -2 7 f 1 Existing Service/Dy Amps J zU J-emVolts Overhead UndgF]rd No. of Meters / New Service rJ Amps 2Q Volts Overhead VUnd2rd F-1 No. of Meters Number of Feeders and Ampacity c,,,., L i No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans: «urr rfluy ue wur veu oy the inspector OJ wires. No. of Total - Transformers KVA No. of Luminaire Outlets No. of Hot TubsGenerators �A No. of Luminaires Swimming Pool_ Above El111❑ : o. o mergency ig hng d. d. Battery Units No. of Receptacle Outlets No'., of.Oifbuirners 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. Ions No. of Alerting Devices No. of Waste Disposers Heat Pump Number .Tons KW _ -- No. of Self -Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems. - No. of Water No. of No. of No. of Devices or E uivalent Heaters KW Si Ballasts Data Wiring: s No. of Devices or E uivalent No. Hydromassage BathtubsNo. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: t Aitacn additional detail cf desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: J7QL (When required by municipal policy.) Work to Start: ve %— / Z 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 0 BOND ❑ OTHER Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete: NAME: !'! Licensee: yy1 / Signature LIC. NO.:,,Z 0 (If applicable, enter- "e m t `in the license number 1" ej r G fj Bus. Tel. No.:� Address: 0 Alt. Tel. No.: *Per M.G.L. c. 47, s-3-7--61, security work requires Department of Public Safety "S" License: , Lie. o. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insur ce coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one wner ❑ owner's agent. Owner/Agent _ (ii / Signature -/'''+ til/ � `� ' Telephone No. ` �d G J �b.�t7 PERMIT FEE: $ S' S fk Mar 21 2012 9:59AM HP LASERJET FAX P• 1 z' CLEAN SURFACE DELEADING � INC. 203 Essex St. (781)340-0816 Weymouth, Nei 02188 FACSIMILE COVER SHEET DATE: March 21, 2012 TO: Director, Asbestos & Lead Program (617)626-6965 Director, Childhood Lead Poisoning Prevention Program (781)774-6700 Board of Health, Town of No. Andover (978) 688-8476 FROM: Mark S. Bianco RE: Notification of Deleading Work 22 Buckingham Rd., Apt. #1, No. Andover, MA PAGES: 3 Mar 21 2012 9:59AM HP LASERJET FAX p.2 COMMONWEALTH OF MASSACHUSETTS Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. Ch. 111, § 197, 454 CMR 22.00 and 105 CMR 460.000 as most recently amended File Number: (AGENCY USE) Contractor performing project Mark S. Bianco License # DC 001055 Lead Paint Inspector Dave Pesce License #UR 4026 Date of Inspection 2/23/12 If low-risk deleading work is being performed, complete the following line: Property Owner: N/A Agent: =__- e 49=1 Building Name (if any) Floor 1 Street Address 22 Buckingham Rd. Apt. No. 1 City No. Andover Zip 01E45 Deleading Method: Liquid Encapsulant etlDry Scrap' ..__._.�Cev�g If "Other" selected, please explain Heat Gun_..Caus Demolition C,,Replacement Other Check One: Dwelling is multi -fancily X Single family Start date 3/30/12 Completion date 4/9/12 When will work be done: A.M. _X P.M. Weekends X Project Supervisor's name Mark Bianco License # DC001055 Property Owner Coram Family Trust Address 36 Amesbury St. City Dracut State MA Zip 01826 Telephone (978)265-1406 In case of emergency contact Mark Bianco Phone: day X617)340-0816evemng X781. 340-0544 (over) Mar 21 2012 9:59AM HP LASERJET FAX p.3 .I Page 2 of 2 4 accordance with Massachusetts General Laws C. 111 §197,454 CMR 22.00 and 105 CMR 460.000, notice of the date and method(s) of emoval or covering of paint, plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received by the following agencies, at least TEN ( 10 ) days prior to the beginning of deleading. NOTIFICATIONS MAY BE FAXED. 1, Department of Labor, Lead Program, Division of Occupational Safety 19 Staniford Street, l" Floor, Boston, MA 02114 FAX: 617.626-6965 2. Director, Childhood Lead Poisoning Prevention Program Department of Public Health, Donovan Health Building, 5 Randolph Street, Canton, MA 02021 FAX: 781-774.6700 3. Occupants of dwelling unit 4. All other occupants of the residential premises, if any S. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (if premises are listed on the State Register of Historic 220 Morrissey Blvd. Places, this notification must be made upon receipt of an Boston, MA 02202 Order to Correct Violations or at least 30 days prior to FAX (617) 727-5128 initiating preventive deleading) NOTIFICATIONS SHALL BE COMPLETED IN THEIR ENTIRETY, DATED AND SIGNED - INCOMPLETE NOTIFICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR & WORKFORCE DEVELOPMENT. PROPERTY OWNER (If owner or unlicensed owner's agent will he performing low-risk deleading work, complete the following): Property Owner Agent(s) Telephone Number (_—)- I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poisoning Prevention and Control Regulations. 105 CMR 460.175, for owner/agent low-risk abatement and containment. [ furthercertif'y that 1 or my agent will be performing the following low-risk activities (I have circled all that apply): applying liquid encepsulant capping baseboards removing doors, cabinet doors, shutters applying exterior vinyl siding covering surfaces I certify that all the information contained in this notification is true and correct to the best of my 6owledge and belief. Dab A 12 Signed��[`��.P,� Revised 1212007