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HomeMy WebLinkAboutMiscellaneous - 23 ELMWOOD STREET 4/30/2018 23 ELMWOOD STREET 2101006.0-0027-0000.0 iI t Date................../ ...... E 40RT#j 1 °.t"`° TOWN OF NORTH ANDOVER ° P s PERMIT FOR WIRING r CHUSEt . Thiscertifies that .......................................... . .............. ................................ r has permission to perform .... , ............ e " . ........................................ s wiring in the building of......................:....:....................................................... at............................................................................... ,North And�&SPE ver,Mass. ................. . ..Fee.��.. .�....... Lic.No���.,��..,nL` ELEC; ' Check # 7799 3 J ILN\ Commonwealth of Massachusetts O ictal Use Only A Permit No. Department of Fire Services Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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 17 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I/ f 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) 3 z�--//Li W elect Owner or Tenant D/47U j Y/1A 06-e A t-111'�,Ci Telephone No. Owner's Address -5,*I, -e Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 15'�G(e -��1�� /�l �Gh.{ Utility Authorization No. Existing Service ,/ Amps /;24, / ''y6Volts Overhead 0' Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity -- 1$ A"he -do Location and Nature of Proposed Electrical Work: 1S t.1J CZ©�h �A- j, -Ir- C, t> 0-/ 1 e4 t`N - UV.- !t2/h, r /91) 1) Lk1.1^-OPr X Completion of the ollowin 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 f No.of Hot Tubs Generators KVA Above In o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. Battery Units No.of.Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesL- No.of Gas Burners o.of Detection and InitiatingDevices No.of Ranges No,of Air Cond. Total Tons g o.o No. Alerting Devices No.of Waste Disposers Heat Pump Number Tons K No.o Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mun'cipa ❑ Other Connection No.of Dryers Heating Appliances Kir Security Systems:* No.of Devices or E uivalent No. of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications firing: t No.of Devices or Equivalent OTHER: i 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: d S fT Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:RAGE: 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:, t0)'$ C ,L LIC. NO.:-'jf 0 E Licensee: 4 s�,.., Stg-1 SignatureLIC. NO.: (P C (If applicable, enter exempt"in the license number line.) Bus.Tel. No.Q� �G/ 7-Y17-Y1f — Address: :;2:3 �(.. nd- SR, 121�^f-Zi � � J�,qy Alt.Tel. No..12K-�'75-2 *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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ A e 6 2 - �, _ � � � � ( 7 �� Y L + The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): j Address: a. -2) l_o City/State/Zip: �1'I/t N G'� Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction e�loyees(full and/or part-time).* have hired the sub-contractors + 2.®'I am a sole proprietor or partner- listed on the attached sheet. $ 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ l am a homeowner doing all work right of exemption per MGL 1 l.❑ 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 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 and penalties of perjury that the information provided above is true and correct. Signature: k4� Date: a `� �� `d Phone#: ` 'I 7LfI 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#: Date....... . .. .'`.... . J NOR7M TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SAcmUto n G This certifies that .......................... A�. ..�..........................Tj1....' C has permission to perform ..... ... ..................... ...........: .... ................ .... . / Ev wiring in the building of.................��f��l............................................... at........... .gid... �!'�..w ....S'?'..............,North Andover,Mass. Fee.....i.p.......... Lic.No...��.... ......................��'��(-.... ....... .. ELECTRICAL INSPECTOR Check # —�-4 —b 7515 Commonwea&of Madbachwef Official Use Only 2epartw t of ire Semiced Permit No. Occupancy and Fee Checked r 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 INK OR TYPE ALL INFORMATION) Date: �1 J,a 107 City or Town of: - f To the Ins ector of Wires: By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location(Street&Number) 0 (f I(nom prj r S` Owner or Tenant 0.,(i Q I R-Qa u I i Telephone No. -980 Owner's Address I(Y%()t) oL 8+ Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building MD 11 St? Utility Authorization No. Existing Service-&D— Amps 1YVolts Overheadi[/� Undgrd❑ No.of Meters New Service JOOL Amps d D/a4& Volts Overhead v❑� Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: o M 6ip A 6 O p o R O N 61D A Pn '.Tj M 1(' )�k , 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 No.of LuminairesSwimming Pool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Batte Units No,of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners o.of etectton and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained 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 WaterKW No.of No.of Data Wiring: .Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: j No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. f Estimated Value of Electrical Work: �� (When required by municipal policy.) Work to Start: 14 14 2 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 penald of per'ury,that the information.on this application is true and complete. FIRM NAME: �C QQ f e l l t C, C� LIC.NO.: Q Licensee: C�Lt,e PG,C� i�_1 Signature F LIC.NO.: (If applicable, nter "ex mpt"in the lic nse number line.) Ven ' �� Bus.Tel.No.: Address: iQ QI�(�j� r /Vui SS•d Alt.Tel.No.: 00 *Per M.G.L. c. 147,s'37-6-1,securi 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: $ r 1 a 2od& R �- f�JL-pT� �/��hlc6CUn)� !3-rte 7 7-0 R14ti, d _ r NEILL & NEILL INS. CO Fax:4137316629 Jun 27 2007 8:55 P.01 ORD CERTIFICATE OF LIABILITY INSURANCE OP DATE A4 FARRE-1 06/27/01 PRODUCER THI$CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Neill & Neill Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 662 Riverdale Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Springfield MA 01089 'Phone:413-732-4137 Fax:413-731-6629 IN$URERS.AFFORDING COVERAGE NAIL# INSURED INSURER Patrons Mutual Insurance INSURER B' Michael Farelli Electrical INSURERC' Methuen NA 0 844 od Ln. INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 30 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSm TYPEOFINSURANCE POLICY NUMBER DATE(MCY MlDOfYYFEOTE PDA fl LIMITS OBNERALLIABILITY EACH OCCURRENCE $1,000.,000 A X COMMERCIAL GENERAL LABILITY CTR0006609 06/10/07 06/10/08 PREMISES(Eacrrwenm) l$50,000 CLAIMS MADE F1 OCCUR MED SSP(Any one person) 35,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2,0 0 0,0 00 POLICY jERCT 7 E LOC AUTOMOBILE LABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea auddek) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY ND"WNEDAUTOS (perawaent) $ PROPERTY DAMAGE $ (Per arrddent) 6ARAGELIABILITY AUTO ONLY-FA ACCIDENT S ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRMLA LIABILrrY EACH OCCURRENCE $ OCCUR CLAIMS MADE I AGGREGATE $ $ DEDUCTIBLE RETEN7 ON $ $ WORKERS COMPENSATION AND TORY LTATU IMITSI ER rMPLOYERS'LIABILITY E.L,EACH ACCIDENT $ ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ If yes desen"beunder SPIAL PROVISIONS below E,L,DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSBMENT f SPECIAL PROVISIONS electrician. FAXED TO 978-682-1480 CERTIFICATE HOLDER CANCELLATION NETHU-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PATS THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAJL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 SHALL l IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATWES. AUTHORIZED REPRESENTATIVE David R. Jarry A464e ACORD 25(2001108) Ca A �e' RATION 1988 Date �,� ?. . . ".�RT:�� TOWN OF NORTH AN EdVER ° A PERMIT FOR PLU BING SSACMUS� This certifies that .��, ��-.l�. u t . • . . •�.� L • •t!t• • • • • . . has permission to perform . . . . . . : . . . . . • . . . . • . . . . . . . . . . . . . • plumbing in the buildings of . . .1'(` 7 .k+.� . . . . . . . . . . . . i at . . , .3. ,�.t�? �'�'0Q `� It `� . • • • • • • . . North Andover, Mass. : . `t.J Fee. . . .Lic. No..f k �/. v . . . . . . . . -«.r�`. Pfl UMBING INSPECTOR Check # C� 71 £ 4 �r of T[k,R COMPLETE ALL INFORMATION MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Check# Z? �5 1i I Date L2 200 Permit# � C,0.9 Building Location 23 Owner's Name (r/&,q Nearest Cross or / Intersecting Street Type of Occupancy EC-51 E^Jcz New❑ Renovations❑ Replacement 2.— Plans Submitted: Yes❑ No❑ FIXTURES x F ceW F 0. IEn w x E. ¢ w O a z 3 x X a U W O W ¢ A ¢ a Q w z A x o 0Q� C w ¢ x 3 o x 3 a o ¢ ¢ w w U w ¢ H U H O x a E~ z O O z w H O U w x w U � z F CIO U. t7 � Q ¢ � G' to V) ' O C7 ' SUB-BSMT. BASEMENT 1 FLOOR t 2 FLOOR 3RD FLOOR 4 FLOOR 5 THFLOOR 6 FLOOR 7 FLOOR 8 TH FLOOR Installing Company Name E 2� . _ ��2 Check One: Certificate Address 6-P, C0 I o t'I ST- ❑ Corporation [vE(Lly, M p 019l5� ❑ Partnership Business Telephone—Area Code( ) [i- Fkrn/Co. Home Telephone—Area Code 070)i ML 9 9 9 B Name of Licensed Plumber _9q 0-t� INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked YES,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 ❑ Signature of Owner or Owner's Kgent 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 Plumbing Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including co m ]ted o,erationslov RESIDENTIAL&COMMERCIAL FEES / Minimum—Up to 2 Fixtures $20 i Z; /Q , WUNATURE OF4fCENSED PLUMBER Each Additional Fixture $10 Under ound Inspection $25 DESIG 2TIS,�1�ID�ICENSE NUMBER OF PLUMBER Partial or Reinspection $25 73 RRENT SERIAL NUMBER Work without a Permit Double the Normal Fee 3 NOTE: Replacement of a Gas Fired Hot Water Heater is$20 EXPIRATION DATE FEE FINAL INSPECTION NO. PROGRESS INSPECTION DATE 200 APPLICATION FOR PERMIT TO DO PLUMBING — DATE 200 TOWN OF TEWKSBURY DATE 200 NAME&TYPE OF BUILDING DATE 200 DATE 200 LOCATION OF BUILDING Street Number PLUMBER LIC.NO. PERMIT GRANTED DATE 200 PLUMBING INSPECTOR t PLUMBER'S COPY a Date.//. ??.X. A.l. . ... .. a a y TOWN OF NORT:KTALLATION OVER } p A • - PERMIT FOR GAS '1sgSSAC NUSEt �b ,ii /� V (s► tla .t"�. . . . . . . This certifies that . .� . 1.G. . . .f V.�. . . . . . . . .�.�. . . has permission for gas installation . . . . . . . . . . . ' / a in the buildings of . . . . �l .4?.u.P.4.. . . . . . . . . . . . . . . . . . . . . . . . . . at . . .p�. .3. . ln.L� .�< . . I. . . . . . orth Andover, Mass. Fee. . lj-�' Lic. No../.?.Y (>«. . . . . . . . . ..-�. .�-. . . . . . �.> GAS INSPECTOR Check# 5803 COMPLETE ALL INFORMATION MASS APPROVAL # t S s `} MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING .� (Print or Type) Check# Z ° °R• E° DZ . L'� 200 Permit# Building Location Z3 e/*jrjCVS) Owner's Name—OL/eiV A l Aw"' _ Nearest Cross or Intersecting Street /Type of Occupancy CA—, New❑ Renovations❑ Replacement Z Plans Submitted: Yes ElNo[I APPLIANCES V z e o U W W W O U H x cn d z � z o w a H H O O m H O w H CIOW d Wx W H a � > d W cW7 w z H z x W w v p > ow Q U a' w F z d W a d > W Z O z O vFi = w W > i a W d d O O W O w F w x O 0 x w 3 0 0 .a U rx > Ca a O SUB-BSMT. BASEMENT 77-FLOOR r. 2 FLOOR 3 FLOOR 4TiFFLOOR S FLOOR 6 FLOOR 7 FLOOR 8 FLOOR /` Installing Com an Name C�i Q y/ C �A abet I Check One: Certificate Address S Ul p 1 ❑ Corporation I .Ali;r s), MA mI S ❑ Partnership Business Tel ph e-Area Code ( © Firm/Co. Home Telephone-Area Code (17 9) 2}- y 9 Name of Licensed Gasfitter . S4-mL,;7' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked YES,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 ❑ Signature of Owner or Owner's 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 gas work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. RESIDENTIAL&COMMERCIAL FEES S )J. Minimum—Up to 2 Fixtures $20 FLJ— Each Additional Fixture $10 SIGNA RE OF LIC N�NED VITTER Underground Inspection $25 L. (,J y Partial or Reinspection $25 DESIGNATION AND LICENSE NUMBER OF FITTER "L j f Z�• Work without a Permit Double the Normal Fee ?—,CURREN S UBER NOTE: Replacement of a Gas Fired Hot Water Heater is$20 SI/ 100 EXP TON DATE FEE FINAL INSPECTION NO. PROGRESS INSPECTION DATE 200 APPLICATION FOR PERMIT TO DO GASFITTING DATE 200 TOWN OF TEWKSBURY DATE ._ 200 NAME&TYPE OF BUILDING DATE 200 DATE 200 LOCATION OF BUILDING Street Number GASFITTER LIC.NO. • PERMIT GRANTED DATE 200_ GAS INSPECTOR GAS FITTER'S COPY c - ,r