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HomeMy WebLinkAboutMiscellaneous - 226 STEVENS STREET 4/30/2018 226 STEVENSSTREET 210/095.0-0011-0000.0 Date.. ................... OF r►ORTIy,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACHUSfc 1 This certifies that , !�-+....... .... . ................................................................. has permission to perform ...�U,. �tn............. '-'e-1........t..�, wiringin the building of...............d............... `�....................................................................... at ..... ...... ...... .f!.......... > orth Andover,Mass. ke cam,' M Lic 9 ELEPRICAL INSPECTOR Check# ) % ( 1215- tom V Commonwealth of Massachusetts Official Use only a Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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),527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL HFORA TION) Date: City or Town of: NORTH ANDOVER To the Inspector of 47rek By this application the undersigned gives notice 2ZkV1W her intention to perform a electrical work described below. Location(Street&Number) � 49 Owner or Tenant M l ,5 C t1 , Telephone No. Owner's Address Is this permit in conjunctionwith building permit? Yes [ No ❑ (Check Appropriate Box) Purpose of Building '�4f-7/JJJ J Utility Authorization No. J - Existing Service Amps / 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: 6Ao,i Completion of thefollowing table may be waived by the Inspector of Wires. / 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 Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones 4NVo.of Switches No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices HeatPum Number Tons KW No.of Self-Contained fJQ No.of Waste Disposers - • 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 i No.Hydromassage Bathtubs No.of Motors Total HTelecommunications Wiring: P t W g No.of Devices or Equivalent u OTHER: e� Attach additional detail if desired,or as required by the Inspector of Wires, r Estimated Value of Electrical Work: � 4t Q (When required by municipal policy.) Work to Start: ,J,l� 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 thepains andpenalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: / Signature 1 LTC (If applicable,enter 'exempt"in the license number line.) Bus.Tel.No �'! '-JlA""+`�^dfJ�/ Address: f 1 Alf s/��f/ Alt.Tel.No .!� "'�7 ,�11, *Per M.G.L�. 147,s'51-6!,/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. $ 2 t; 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 Q 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. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: . 4 Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: I Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: t Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comment . Inspectors Signature: U r Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com a The Commonwealth ofMassachusetts - Department of IndustrialAccidints 02 Office of Investigations 600 Washington Street Boston,MA 02111 UV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): / - " Address: . City/State/Zip: '� _ Phone#: �+ p F Are y 2wan employer?Check the appropriate box: Type of project(required): 1.MOT 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.❑ I am a sole proprietor or partner- listed on the attached sheet. F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g ❑Building addition [No workers' comp.insurance 5. El 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.❑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.] r *Airy 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 ai-e 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.. CV1105 <:Z-) , Polic #or Self-ins.Lic.#: ,!°`! �{ y Expiration Date: Job Site Address: « City/State/Zip: `i 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 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. d0 hereby Certl under th alnS andpenaliles ofperjury that the information provided above is true and correct. Signature: Date: ,r� Phone#: /.✓ f A=P'.` 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#: O 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 ofhire,- 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 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: The Commonwealth of Mgssachu tt, Department of Industrial.,Accidents Office of Investigations 600 Washington Street Boston,MA,02111 Tel#617-727_4900 ext 406 or 1-877 MASS.A.FE Revised 5-26-05 Fax#617-727.7749 v+www.znasa,gov1dia e J COMMONWEALTH OF MASSACHUSETTS z BOARD OF i i' Et_ECTRICIAMS I ISSUES TME FOLLOWING LICENSE ; ! Ck AS A ,RE,G JOURNEYMAN ELEC:.R I,C I AN\ ++F z PAUL ti MINER 9 TANSY LN (' _ STRATHAM,; NH 03885-2289 83742 26824': E 07%31/ifi TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law •Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion, improvement,-removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building"be done by registered contractors, with certain exception, along with other requirements. Type Of Work: 5.88kW Roof-Mounted Solar Array Installation Est. Cost 22,062 Address of Work 226 Stevens Street Owner Name: Kurt Muttelstaedt Date of Permit Application:. 7/28/2014 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent a owner: 7/25/2014 Harmony Energy Works Incorporated 179360 Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name 4'-0" o D E3. D ❑, D D D N TI rs M14'-0" . 16'-0". s I i6'-11" I I I I I I I I I I I I I 16'-11" I MD o. I I I I I I I I I I I North io I 16'-11 I I I I I I I I I I I I Is'11" I Roof M ih I I I I ) I I I I I I I I I I I 1 1 1 1 1 1 13'-9" di o D. '-0 ❑ o, o o — 14 " 12'-9" ' N s M I I I I s I I I I I South I I I I I I I I I I 1 I I I I I I Roof X 38-EcoFasten Quik-Foot Iron Ridge XRS Rail 1To° Roof Pitch=221 2-192"(16') Pz"�jP 8-168"(14') �--�• Harmony urt itte stae t 1s—End Clam c_:,xD Clamp PV ARRAY U l ENERGY WORKS 226 Stevens Street North Andover MA 34-Mid-Clamp Manuf/Model SOLAR WORLD SW280 10 Gale Rd,Hampton,NH Roof-Mounted Solar Array 2x6 Roof Rafter,16"Center Module Rating (W) 280 603-926-3366 Splice Bar(4)&Bonding Jumper Dimensions 39.41"x 65.94" harmonyenergyworks.com 5.88 KW DC © WEEB 6.7 Ground Lug #of Modules 13+8=21 DRAWN BY H SARGEANT A M #6 Bare Copper Equipment DC Output(KW) 5.88 KW DC A APPROVED BY G HORROCKS SCALE 3/1611=111 SHEt 1 OF 1 t MODULE Power(W) Voc(Vdc) Vmp(Vdc) Isc(Adc) Imp(Adc TC(%/°C) Max Fuse SW280 280 39.5 31.2 9.71 9.07 -.30 15 3/4"EMT, a a a a o a o 0 0 0 0 0 0 3-#10 AWG 1 -#8 GND Northern Roof String .................. +_ +_ Sofa-Dock +_ AC Combiner (MLO) _ G -OND ti ti v 't ti ti n 30 A SLAC - t o RED-Li O 20A o a (� ling a a � o o -...-..BLUE-NEUTRAL Soulthern Roof StrI �0 10A +_ +_ I +_ +_ 11 +_ I +_ +_ .. ....................... _ Sola-Deck G REo-LI 3/4"EMT, BLUE-NEUTRAL 3-#10 AWG 1-#8 GND ........................... _ TO UTILITY fERVICE Utility Meter Main Service PV Revenue Panel Grade AC 200A Production Disconnect Meter 240/30 BLACK-Li -L1 BLUE-NEUTRAL M L2 O Back- Fed Breaker 3/4"EMT, 30/2 3-#8 AWG Load-side Tie-in 1 -#8 GND T * LA INVERTER RATINGS MANUFACTURER ENPHASE MODEL# M250 •-- Kurt Mittelstaedt MAX DC VOLTAGE 48 VDC f ;� �' ]Harmony MAX PowER@40C 250 WAc LLL]"- 1 ENERGY WORKS 226 Stevens Street North Andover MA DC INPUT RANGE 16-48VDC OCPD(Rear Roof String)=13 x 1 x 1.25=16.25(20A) 10 Gale Rd,Hampton,NH Roof Mounted Solar Array—3-Line NOMINAL AC VOLTAGE 240 VAC OCPD(Front Roof String)=8 x 1 x 1.25=10(10A) 603-926-3366 MAX AC CURRENT 15_A Ganaonyenergpvorks.conr 5.88 kW MAX OCPD RATING A (AC� DRAWN BY H SARGEANT SIZE FSCM NO DWG NO REV APPROVED BY G HORROCKS SME N/A sae_r 1 OF 1 A 0 Revenue Grade PV ARRAY Utility Meter Manuf/Model SOLAR WORLD SW280 (On North Side) Production Meter Module Rating(W) 280 (In Basement Dimensions 39.41°x 65.94" Adjacent to Main #of Modules 13+8=21 DC Output(KW) 5.88 KW DC Panel) Northern Roof String Main Panel (In Basement) r Micro-inverters are located directly . beneath each module Southern Roof String a. Roof Pitch=220 N Harmony Kurt Mittelstaedt Ut"=��o° t�:__.''J ENERGY WORKS 226 Stevens Street North Andover MA aZ 10 Gale Rd,Hampton,NH Roof-Mounted Solar Array 603-926-3366 harmonyenergyworks.cone 5.88 KW DC SIZE FSCM NO DWG NO REV DRAWN BY H SARGEANT A APPROVED BY G HORROCKS scram NSA saEFr 1 OF 1 ti Project Report Ans, IRONRIDGE Solar Mounting Made Simple Project Details Name Mittelstaedt-Northern Roof Date 20i4-08-04 Module Solarworld:Plus SW 280 mono Total Modules 13 Dimensions 39.4"x65.9"x1.2" Total Watts 3,640 Tilt 220 Attachment Pts 24 Load Assumptions Building Details Wind Exposure B 'Building Height:30' WindSpeed_100�np_Ll Roof Slope 22° Ground"SnowLoad60-psf Risk Category Attachment Spacing 4.0 ft Engine a ring Validation RAILS XRIO XR100 XR1000 TOTAL PROJECT COST $1,184 MAX,SPAN' [portrait] Zone 1 3' 4'5" Zone 2 3' 4'5" 5'9" Zone 3 3' 4'5" 51911 MAX CANTILEVER [portrait] Zone 1 1'2" 11911 2'4" Zone 21 2" 1'9" 2'4't Zone 3 1'2" 1'9" 2'411 LOADS ZONES(portrait) DOWN 1 (lbs) UPLIFT] (lbs) LATERAL H(lbs) Zone 1 396.0 -89.0 144.0 Zone 2 396.0 -156.0 144.0 Zone 3 396.0 -248.0 144.0 SubArray Information Columns Rows Orientation Splices Required Rail Provided Rail Attach Pts Clamps is � np es 9 1 Portrait 30' 1 set of 31.0' 16 4 End Clamps 2 [1 x 17,1 x 14] 16 Mid Clamps 2 1 Portrait 611011 1 set of 11.0' 4 4 End Clamps 0 [I x 11'] 2 Mid Clamps 1 set of 11.0' 4 End Clamps 2 1 Portrait 6'10" [1 x I P] 4 2 Mid Clamps 0 f Weight Details Total Weight Weight/Attachment Distributed Weight 736 lbs 30.7 lbs 63:1-p f) II +t I Project Report -ArIRONRIDGE Solar Mounting Made Simple Project Details Name Mittelstaedt-Southern Roof Date 2014-08-04 Module Solarworld:Plus SW 280 mono Total Modules 8 Dimensions 39.4"x65.9" x 1.2" Total Watts 2,240 Tilt 220 .Attachment Pts 14 Load Assumptions Building Details Wind Expos_ ure B Building Height:30' Wind peS ed.100=mph Roof Slope 22° Ground Snow Load60-psf Risk Category Attachment Spacing 4.0 ft Engineering Validation RAILS XR10 XR100 XR1000 TOTAL PROJECT COST $755 MAX SPAN [portrait] Zone 1 3' 41511 QS-E) Zone 2 3' 415-1 5'9'1 Zone 3 3' 41511 5'9" MAX CANTILEVER [portrait] Zone 1 1'2" 1191, 2'4't Zone 2 1'21t 11911 2'4" Zone 3 1'2" 1191, 2'4" LOADS ZONES(portrait) DOWN (lbs) UPLIFT T (lbs) LATERAL H(lbs) Zone 1 'zz396:0D -89 0- 144.0 Zone 2 396.0 -156.0 144.0 Zone 3 396.0 -248.0 144.0 SubArray Information Columns Rows Orientation Required Rail Provided Rail Attach Pts Clamps Splices 1 set of 28.0' 4 End Clamps 8 l Portrait 26'8" [2 x 14'] 14 14 Mid Clamps 2 Weight Details a r Total Weight Weight/Attachment Distributed Weight 458 lbs 32.8 lbs psf i Date.,3 ........ NORT" °�,�``°:•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SSACMUS� This certifies that ..............�.....: , ................................ has permission to perform ' '. :�r�'"--! ....................................... wiring in the building of...." z z .L.��aa� North Andover,Mass. 2 Fee..4 .'-.... Lic.No�. /�1. ......... . . . ELECTRICALINSP R � Check # 806.1 P -\ C'ommonwea&o f Majjackuaetfa Official Use Only QA Apartment ol3ire Samicea Permit No. Occupancy and Fee Checked 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 IN INK OR TYPE ALL INFORMATION) Date: 3- - p R__ City or Town of: A,,o" 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) 02 (f 1—e✓e NS S f Owner or Tenant A—_y r Z,? t Telephone No.97-�L 11S7 b!G> Owner's Address Z,14 S 12-ve," , Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building I?e.3 al, Utility Authorization No. !9,3 - 9'/.0 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Roo Amps Jho /,76/9 Volts .Overhead U; Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (f Te t e e- - o /aa v 4 .r?®Q res Inrff� /- Completion Com letion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeilSusp.(Paddle)Fans No.of Total : Transformers KVA r No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ Wo-.75fUnits Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Ranges No.of Air Cond. Total No.of Alerting Devices No.of Ran g Tons No.of Waste Disposers Heat Pump I.Nyp!ber I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El other p g Connection No.of Dryers Heating Appliances Key Security Systems: ry No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Y 6_00• (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 the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: T3p gUS01cd>'1 Signature LIC.NO.:1119-'6_&_y (If applicable,enter,A"xempt"in he license number line.) Bus.Tel.No.:,97F ySlq13a3" Address: 2 ! Me_,P, Noe &7— '-awe 1/ /,�. GI/�v'�� 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 Signature Telephone No. PERMIT FEE: $ I 9 U 4 u /C G G3 r The:Commonwealth of Massachusetts Department of Industrial Accidents idfrice of Invesd9ations ilii 1 600 Washington Street y , Boston, MA 02111 t z www ntass.gov/daa . Workers' Compensation Instrance Affidavit: Builders/Contractors/Electricians/Plumbers konlicant Information i Please Print Legibly Name(Business/Organization/Individual): 21eJ2a rZ �ee-?V S c )e i 1l Address: �l t^ City/5tate/Zip: lows k v Phone#: . 92a¢"_ 151 - 13 0L_ Are you an employer?Cheek.the appropriate-box: Type of project(required).- 1. requites:1.Q I am a employer with 4, ❑ I am a general contractor and 1 6. ❑New construction ployees{full and/or part-time).* have Fired the sub-contractors 2. I am.a.sole proprietor.or partner- Iisted on the attached sheet.i 7. Q Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for me in any capacity. workers' comp.insurance._ g, Q Building addition [No workers'comp, insurance 5. ❑ We are a corporation and its requireti] officers have exercised their 10.[KElectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions myself.[No•wor6ns'comp. c; 152, §1(4),'andwe have no 12.Q Roof repairs insurance required.)--t employees. [No workers comp.'insurance required.] I3:Q.Other *Any applicant that checks boil#l most also fill out the section below showing their wo&wV'ooimensation policy information.. t Homeownerp who submit this affiddvit indicating they an doing all work and then hire outside contractors must submit a new affidavit indicating such. $Conowiors that check this box mustatai died an additional shearshowimg the name of the sub-ammuctots and their workers'comp.policy information. l am.an employer that rs pr4gWirmg:workers'compensation insaranae for nty.&ttployeea Below&-the policy ar'td job site information. Insurance Company Name: ' Policy#or Sel#-ins. Lie.#: Expiration Date: Job Site Address: City/statezip: 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 tar►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 DTA for insurance coverage verification. I do hereby certify under the pains and penaUses of perjury that the Wormadan provided above is true'and eonrA Signature: Date: Phone#: O,fficial 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#: I NpRTM TOWN OF NORTH ANDOVER F F PERMIT FOR GAS INSTALLATION v �9SSAcHUSES�y , This certifies that .&/:-.1. . .. .�. . .4 . . . . . . . . . has permission for gas installation in the buildings of .� �(!. . /� ��!� . P �. . . . . . . . . . . . . at -1)7,44,� . . . .?�.7 � -!f . ., North.Andover, Mass. Feer . . . Lic. No.. .. . . . .. . . . . . . . . . . . . . . . . . . . . } GASINSPECTOR t Check# { r. 6454 MASSACHUSETTS UNIFORM APPUCATON FOR PERNUr TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHZSETTS c BuildingL ations Pa�ts J� Qe` Permit# `/ , Amount S Owners Name New® Renovation Replacement 1; V Plans Submitted 0 Z tax m w w a O o = O z F C z V trd] x y Z F' a Q C > W -� a x a a w > F Ga F x Z d w d C F^ > �n m Z O z W F w x o x 3 c U a o z > c SUB -BASEMENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) ` f i Check one: Certificate Installing Company Name j 1-1 Corp. Addrg e �i^o_ �c'C L, v-L R- ti . 036 h 1-1 Partner. Business a ep one — irm/Co. Name of Licensed Plumber'or Gas Fitter ___Ke1J,-yv Ck INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes No 1:3 If you have checked yes,please ind' to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond 13 Owner's Insurance Waiver: I Arn 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 13 Agent 13 1 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts St as Code a Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or as Fitter Title Plumber Z1 �y City/Town 1:3 Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) F�meyman Date 6e. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 'SSACMUS� This certifies that . . . .�. .�. L. . . . . . .. . . has permission to perform . . . .O�/i A .A.. . . . . . . . . . . . . . . . . . . plu g in the buildings of . . �! ,S7`�vC,y�,j�`"":. . . at. . . . . . . . . . . . . . . . . /.�/�.r.�...�. , North Andover; Mass. Fee.-,50 . .: .Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 7763 . MASSACHUSETTS UNIFO RM APP LIGATION FOR PERMIT TO DO PLU MBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location 2U:�' Owners Name J 2�� � 0.r 7`Lj� �(r TypeofOccupancy S�a . P w1 Amount New Renovation Replacement ' Plans Submitted Yes No El FIXTURES I o � FA U0 A ry cq 541 Tt�411�II�II' � ]n bum < 2%FLOM 3MIbI M i 41iFI lti-OM SII3 F OM 6MFLOOR 717rI1EI�3 R . SISI I"7AQt (Print or type) Certificate t Check one: Installing Company Name_ ,/ (- 1p a Corp. Address _� ke lot y Z 1 Pel t'LC,k� , �. Gi. 30 7 Partner. usmess I elephone T03 63 ID ci 3 � o. Name of Licensed Plumber. K.e-u' n j4 Insurance Covem-e• Indicate the type o insurance cover ge by checking the appropriate box: Liability insurance policy Other type.of indemnity [] Bond ri Insurance Waiver: I, the undersigned,have been made aware that the licensee of this applicatio•n does not have any one of the above three insurance Signature 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach tts State Pbing Code and Chapter 142 of the General Laws. By: 7gnaLure of Limnseec p um er Title 1 9 Type of Plumbing License City/Town 11,40 icenseum er ❑ APPROVED(OFFICE USE ONLY Master Journeyman I Date.'.. . ... . . . . . i ".O RT:�tio TOWN OF.NORTH ANDOVER p PERMIT FOR PLUMBING S ,SSACMUSE� This certifies that . . . . . . . . . . . . . ''��. . . . . . . . . . . . . . . . . . . . ` has permission to perform . . . . r?" . . . . . . . . . . . . . . . . . . E` plumbing in the buildings . . . . . . . . . at . . . . . . . . . . .. North'Andover, Mass. Fee*9 . . . .Lic. No7�1gYP . . . . . . . - Ac . . . . . . PLUMBING INS ECTOR lti/ Check .7 i 7695 Engin�srs /0 ; �5 CC) Ip April 17,200$ MI"1;'n_MWIl L ng' Mr.Dan Monmarquet D&R Builders 12 Virginia Avenue Lowell,MA 01852 (978)852.5643 Re: 226 Stevens St.Addition—NoAndover� A. Review of Installation of New LVL Beam Support of Existing Roof Rafters Dear Dan, Based upon observations completed yesterday afternoon by my authorized representative during construction at the above noted project, I hereby confirm that the completed construction is in accordance with our written recommendations dated January 25, 2008 as well as the applicable regulations and requirements of Section 116 of the Sixth Edition of the Massachusetts State Building Code. Two variations were observed as follows: An equivalent(2)double 13/4"x 117/8"x 25'-0 multi-span engineered LVL beam supporting the existing roof rafters above the existing kitchen partitions does have one span that is 12'-0" and this is acceptable. However, the center post consists of only (2) 2x4's. This correction was provided verbally and is understood that it will be corrected to (4)2x4's at a minimum. Upon completion of this post reinforcement,there shall be no outstanding concerns. No additional review has been completed for the remainder of the existing and new construction completed at this project location. Sincerely, TF Moran,Inc. y,�0-' of MA q o� KYLE Gs E. v ROY m STRUCTURAL No.46180 KIST E.Ro E. SECB g9o,�s G+sT�R �``Q Y Y, , SJpNAL Senior Structural Engineer Cc: FILE 48 Constitution Drive Bedford,NH 03110 Phone(603)472-4488 Fax(603)472-9747 www.tftnoran.com New Hampshire Office Locations: Bedford I Manchester I Salem I Keene Y � i I -''�•, .f`� ��g al'. ��.1 � .'.�''.: F<y Engineers a January 25,2008 Mr. Dan Monmarquet D &R Builders 12 Virginia Avenue Lowell, MA 01852 (978) 852.5643 C/O Michael Malynowski—WIT Design'Consultants Inc. Ike: 226 Stevens St.Addition—No.Andover,MA. Review of New LVI.,Seam Support of Existing Roof Rafters Dear Dan, TFM has reviewed the new(2) double 1 V x 117/8"x 25'-0 multi-span 1.9E LVL beam proposed for support of the existing roof rafters above the existing ldtchen partitions. This beam is adequate for the support of the existing roof rafter framing, once gang nailed together in accordance with the engineered lumber manufacturer's recomialendations and supported by posts such that any one span shall not exceed a length of 11'-0". This review is based on the attached drawings (SK-1, SK-2, & SK-3)provided by your office. No additional review has been completed for the remainder of the existing and new construction proposed at this project location. OF Sincerely, TF Moran,Inc. E Kyle E. Roy, , SECB Senior Structural Engineer Cc: Michael Malynowski r MHF Design Consultants,Inc. c 48 Constitution Drive Bedford, NH 03110 Phone(603)472-4488 Fax(603)472-9747 www.tfmoran.com New Hampshire Office Locations: Bedford Manchester Salem I Keene MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location 2 S t SOwners Name �(� ��S C Pe Date # 4- Amount C• Type of Occupancy New Renovation r-ao� Replacement " Plans Submitted Yes No ❑ FIXTURES z F x V D O OEr .arA a L5 O oa STSBM ELM= M FLOOR �11IDCg2 4FH FLOOR 5IH H M I —I—I 44� 6M FLOOR - 7M FLOCR SIH FL" (Print or type) Check one: Certificate Installing Company Name 7( Y �- 13 Corp. Address `e t � Partner. 1 ej 3 C> Cp usmess Telephone 1�, _ c S Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature� 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 performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbin ode and Chapter 142 of the General Laws. By: Igna ure 51717censecirIllm er Title Type of Plumbing License - CityZ�/Town rcense NumSer Master ❑ Journeyman APPROVED(OFFICE USE ONLY Date.. -.0.3....... ,aOFT 0 TOWN OF NORTH �NDOYER PERMIT FOR GAS INITALLATION CHUS Et This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installat/on in the buildings of . .�77 .. . . . . . . . . . . . at . . . . . . . . . North Andover, Mass. Fee. . . . . . Lic. Noz�/ GAS I t��P,&; rR' Check#. 6365 MASSACHUSETTS UNIFORM APPUCATON FOR PUM T)DO GAS FITTING (Type or print) Date V,= r� NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# Amount$ Owner's Name •-� � �' New Renovation Replacement D Plans Submitted p Z Z F ' I O j W p O ;D 0 z F .2 w °� z v W v, z CF a O a > W C7 N z . F z x w a w cG w F w x C z w Q z �- > m z o z o z O x 3 0 .da o > SU B -BASEM ENT B A S E M ENT 1ST. FLOOR It 2ND . FLOOR 3RD . FLOOR 4TH . FLOG R STH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR f (Print or type),-Z Name P- Check one: Certificate Installing Company 1n , _ 'I,d Corp. r�' — Address __� 6(J��,P Partner. `fir 1 I2Q 1-1~ i1=N . Q3cO lo Business Telephone lbo'3 - (63s'- I5 �F-irrtr/Co. Name of Licensed Plumber'or Gas Fitter f�l��Jrt1 �ct n INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes N If you have checked es lease indicate the L..p type coverage by checking the appropriate box. Liability insurance policy ED _. Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: l,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 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 performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachuse 6as Code a apte�l 2 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title [j umPlber City/Towm Gas Fitter � E] GasNumoer Master APPROVED(OFFICE USE ONLY) Journeyman NpRTH Of ...° ,e 1ti0 F� °p TOWN OF NO H ANDOVER • PERMIT FO AS INSTALLATION Ja h �,SSACHUSE�,( This certifies that . . �P. . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . in the buildings of Apl e b.!. . . . . . . . . . . . . . . . . . at .2 2! . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.:??. ?:77. . Lic. No j .,.5. y . . . . . . .Y rs- . . . . . . . GASINSPECTOR Check# } t 7 t 6225 I i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING -� (Print or Type) — ` � Mass. Date �l' t9�Permit # ` - Building Location ��6 S1��ri /S d5% Owner's Name � � j Ldsr.4£0T �l )Dt,�"cL i✓ �'7S Type of Occupancy-S/ GA f-/i✓» New ❑ Renovation ❑ Replacement ❑ Plans,Submttted: Yes❑ No ❑ N H W_ N J* x s tlf N V •d Q A V N ¢ 0 = N W ¢ O j m v , ¢ � t > 2 O }' W ID N hail W O O 6 C < Uj `v LU o � Z� J CC Y Z F W yZj O O > W. J (N.. W A I Z t W W a O at F- h 0 e > c a ir- o SUB—BSMT. BASEMENT 1 ST FLOOR • 2ND FLOOR OR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH•FLOOR 7TWFLOOR . BTHFLO0R, Installing Company Name Zc, Lam - Check one: Certificate Address C> a O a– c� ❑ Corporation c, -,c o13'6 / ❑. Partnership Business Telephone -77 Pil Firm/Co. Name of Licensed Plumber or Gas Fitter 6/3 AZL INSURANCE COVERAGE: I have a current I• ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes (r No ❑ If you have checked Yes, pleaseIndicatethe 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 ❑ Signature of Owner or Owner's Agent I I hereby certify that all of the details and information I have submitted(or entered)in above application are true and ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this applicato a in com iance with all pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the Gene s. By TFjpWlUnse:' r gnatu f Licensed lum r or G itter Title r /License NumberGty/Town man AP0R011ED( I US. NL w BELOW FOR OFFICE USE ONLY FJINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION.FOR PERMIT TO DO GASFITTINO NAME 8 TYPE OF BUILDING _ LOCAT19M OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE x.,_19 OASINSPECTOR