Loading...
HomeMy WebLinkAboutMiscellaneous - 231 MIDDLESEX STREET 4/30/2018 231 MIDDLESEX STREET 210/014.0-0039-0000.0 F NORT}f q o - Town of North Andover it qf0(w1lMwM1w D.B.A.—Zoning Compliance Form q ��� 978-688-9545 Sq CHUSE This form must be reviewed with the Inspector of Buildings. Office Hours are Monday-Friday 5-10 am,and 1-2 pm Monday-Thursday. Soo Applicant Name: 6c AkI Name of Business: Address of Business: Zoning District , i Map C�I Lot OG % ; Phone: C`7� — �vi 1 �' ��S� Email Nature of Business: & c ca I Do you own this property? Yes ;K No If no, written permission is Y fi-om d re re q uiour landlord. t Will you have clients coming to this property? Yes No ! Will you have any employees? Yes No } Will you have any major deliveries? Yes No_./ Description of Business Activity(Must be Completed) Signature.of Applicant i For Signage Refer Orth Andover Zoning Bylaw Section 6 j The propose ee n� se ' s zoning trict. I Issue y a e f I ' i i 2.40 Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address,which is clearly secondary to the use of the building for living purposes. Home occupations shall include, but not limited to the following uses; personal services such as furnished by and artist or instructor but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods,which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi-family district for a home occupation,the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said dwelling. b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings,or display which are not customary with residential buildings; d. Not more than twenty five (2S)percent of the existing gross floor area of the dwelling unit so used, not to exceed one thousand (1000)square feet, is devoted to such use. In connection with such use,there is to be kept no stock in trade,commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance,omission of odor,gas, smoke,dust, noise, disturbance, or in any other way become objectionable or detrimental to any resid tial use within the eighborhood; g. ny suc bu' ding shall incl no features of design not customarily in buildings for residential se. S' nature Date Date l.t].:2%3?p;NOpr`:'��ppL ..�A.--2............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................................................................................................ has permission to perform ..Lk.f -etsJe— ....�x ....................................................................................... wiring in the building of... .......................................................... ................................... at .......22) VA( pth rth Andover, as AA d Mas................................................................................................. "OV ..M. . .. .. W................. . . ....... ..... ..... ..... EL CAL INSPECTOR Check# 4 12.021 Commonwealth of MassachusettsOfficial Use Only o Department of,Fire Services P ermit BOARD OF FIRE PREVENTION REGULATIONScupancy and Fee Checked M 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: &21/45 y' 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) 231 _ t Owner or Tenant Tae f Owner's Address Is this permit in conjunction with a building permit? No (Cheox) ) Purpose of Building Utility Authorization �1 1® Existing Service E= Amps 2 V / Z<I JJolts Overhead Undgrd❑ ew Ser Z00 Amps d /Z40Volts Overhead Undgrd ❑ No.of Meters Feeders and Ampacity Location and Nature of Proposed Electrical Work: ��a oviT— L P PT ® 76 Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA , �t No. of Luminaires Swimming Pool Above ❑ In- ❑ o,o mergency Lighting rnd. Md. Batter Units �. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones t- No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total No,of Alerting Devices Tons g Heat Pum Number Tons KW No.of Self-Contained No.of Waste Disposers Totalsp �"""' """"""""' 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 No.of No.of Heaters KW Data Wiring: f Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: t-- No.of Devices or Equivalent 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: 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 covers is in force,and has exhibited proof of same to the permit issuing office. �•(� CBECK ONE: INSURANCE ND ❑ OTHER ❑ (Specify:) certify, under the pains and penalties ofperjury,that�l�iZY ation on this application is true and complete. FIRM NAME: C',� LIC.NO.:j,S� 6— Licensee: _ ""� Signatur cc.ts� IC.NO.: (Ifapplicabl enter "exempt"in the license numberline) Bus.Tel.No.• Address: (95� Alt.Tel.No.: 3 " *Per M.G. c. 47,s. -61,security work requires epartment of Pu he 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:$ ❑ 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. 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 rd 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 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INVECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comme s: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed ❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Com e t �—^ J f Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington. Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectrriciansfrIumbers ,Applicant Information Please Print Legibly Naxn.e(Business/Orgatdzation/Individual): Address: % ® 0 D -- -O - City/State/Zip: ��� Phone#: %��' ?ly Q/ 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 enloyees(full and/or part-time).* have liired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. �• E]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. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3111 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 .re uiredemployees.[No workers' required.) 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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 isproviding workerscompensation 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$eclaration 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. " I do Hereby certiry under the pains andpenalties ofperjury that the information provided above is true anti correct. - Si atur k-� Date: '1 PhoneUtq - 423-9907 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License 0 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 M information and Instruction's 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 752,§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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of 1 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 LTC 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. Anew 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 burn 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 massaclhvsPt€s Depaztixi.ent oflndustdal Accidents office of Investigatio.11s 600 Washiagtoa Street Boston,MA 02111 TOL#61.7-727-4900 ext 40'or 1.-877,M.ASSAFE Revised 5-26-05 Fax#617-727-7749 Bio COMMONWEALTH OF MAW&USETTS r .:.BOARD': - � d ELECTRICIANS ' 4. ISSUES THE FOLLOWING it AS A R JOURNEYMAN :ELECTR-ICDA J0fL:i'A WINSLOW 4' AMB ERWOt?D .DR , ,Z'r. ATK.I NSONNH 0381 1-226 35094 01/3�1t6 47955 y Date.c-'�—"'.2 . . .. . . NORTH OF TOWN OF NORTHANDOVER 11 • PERMIT FOR-GAS INSTALLATION �t �9SSAG NU`�Ett This certifies that . . . . !. . .�.. . . .l. . . . . . . . . . . . . . . . . . . . . . . . 2 1 has permission for gas installation . . . . . . . . . . . . . . . in the buildings of . . .��? . ../... .. . . . . . . . . . . . . . . .. . . . . . . . . Y at . . . . . . . . . . . , North Andover, Mass. Fee Y . ... . . . Lic. No.lv.``f.?. . . . . . � GAS INSPECTOR Check# /(L u -a 6504 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) eU1, Mass. Date� 200 City, Town Permit # Building © Owner 's h� 1 AT: Location—?— Name �� eS I011l(1.7�iV �� s Type of Occupancy: e G New ❑ Renovation [� Replacement ❑ Plans Submitted Yes ❑ No cc a w H to v cc F oNc W W N x O V m F y. W C7 J a W h �. z 0 OC z O W a ¢ x 0 O G Z W W F- to t7 W < Z 1- y o u > LU W cc N CC r V W N W 6 a f. C I- X -j Z Q W O > lt. - V J W 4 W W tY W aO Z Q N < O O W O W ac H SUR—BSMT. . BASEMENT ' 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 6TH FLOOR 6TH FLOOR 7TH FLOOR LOTH FLOOR e: (Print or Type) Check O Certificate Installing Company Name t� S ! ;N{ .�,I� [Corp. Z?I—) G Address P-110 Z. ❑ Partnership aa'Aa -40 K6Z Firm/Company Business Telephone (4~ M Name of Licensed Plumber or Gasfitter 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 s State Gas Code and Chapter 142 of the General Laws. provisions of the Massachusetts P 1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner.Agent 1 have a current liability insurance policy to include completed operations coverage. ❑ By j/TYPE LICENSE: ` / Signature of Licensed Title Plumber Plumber or Gasfitter asfitter c� City/Town — Master ���L/ APPROVED (OFFICE USE ONLY) ❑ Journeyman License Number Fnou 1IJAI ✓.w�n 1 QAQ Date. "OR'M TOWN OF NO H ANDOVER PERMIT FOR PLUMBING �SS'cHUS LL �, This certifies that . . . . . . . . . . . . . . . . . . . ... has permission to perform . . . . . . . . . . . . . . . . . .. plumbing in the buildings of .. . . . . . . . . . . . . . . . at. : .. .�. .,�/y� . . . . . . . . . . , Nth Andover, Mass. . . . . . . �.)Fee.IV?. Lic. No.. .. . . . .: -'7 -� . . . . . PLUMBING INSPECTOR Check # l t ) u 7815 SID .� 'MASSACHU#TT'S UNIFORM gpp�C \ IArbriaTYw) ; ATION FOR PERMIT� TO 0p PLUMBINQ BuUdind Loa Mme' Date —22- . '"y I PemYtt (r( ) OWnera Nama New QType of Occutxnry = Renovation (H� Replacement Q Plans Submitted: Yes IJ No O FIXTURES z v, z a z x — r» di a 0 x < WQ W h .. 0: a ~ W h ¢ C N � O . Z e: W dl Y < a W x S{ a a z ec a ,i; O z zO-K h W o a '� i 0, s } SUA—BSMT. ¢ a O BASEMENT IST FLOOR 2ND FLOOR SRO FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Instaillnp company pa Y Name ilete Address i �k one:. Cerunate I Business ' v =ion Telephone L Name of Ucensed Plumber O Partnership i Q Flrm/Ca. INSURANCE COVE RAGE: I have a curre Ilabfl I RY ns Yes �i urar>� pdicy or Its . [9 substantial If you No O equivalent which Y have checked MCats the require Yl�. pleased indicate the tents of MGL Ch. 14 tYlae c 2 coverage A liability Insurance f by checking the apprOPriate box policy �I OWNER'S INSURANCEOther type Of Indemnity p Chapter 142 or WAIVEt: I a.. aware 6or>d Q the Mast. Gene Laws, and that the licensee, v that my signature on this��' die Insurance coverage required by nature o i permit apWllatlon watt' q Owner or es this requiremenL er s ent Check one: Ihereby and�Y that all of the datUs mer Q Agent❑ pertinent knowledge o ItM rnbrr�" in W atioiiaw wtNnityd�r entered)in abm �, Massachu State Plumbing rlo. under the perm"isa;w fa Plication are true and 400urate to Chapter 142 of application will by the bast of m Mral Law=. M compliance Y Title PI n�with all Dna n um r City/Town TYPO of Lice . �'VF nse:tLtaster LY Lam"'. License Number �urdeynyn E ' i , i ' i