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HomeMy WebLinkAboutMiscellaneous - 24 MARIAN DRIVE 4/30/2018 (2)� � 31i........... ti Date ................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... ..................... ............................. .......... has perrmssion to perform., ...................... wiring in the building of ........ ........ 4 5 . .. ..... . ............................................................. atq2+ ......................................................................................................... . North Andover, Mass. Fee...'�� .. . ....... Lic. No ?A.. .................................................................................... ELECTRICAL INSPECTOR Check # i S4 Commonwealth of Massachusetts Official Use Only 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 NK OR TYPE ALL INFORMAMA9 Date: 3 -di -IG 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) ' � e{ m Lir 1 A r 1)r " y .2 Owner or Tenant Owner's Address �VR- Telephone N0 1 9 0 Is this permit in conjunction with a building permit? Yes ❑ No [9"" (Check Appropriate Box) Purpose of Building Setry c,L ��p q rc� _ Utility Authorization No. E 0 3®� -Existing Service /0() () Amps /,?,o / o?YC) Volts Overhead [�K Undgrd ❑ No. of Meters f New Service a_9 Amps /00 /off yv Volts Overhead 19-111' Undgrd ❑ No. of Meters Number of Feeders and Ampacity Z g -aU A A2 O -30 Am /_p � � �i►�11P Location and Nature of Proposed Electrical Work: i p- A r(A Completion of the following 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 No. of Luminaires Swimming Pool Above ❑ In- Elo. rnd, rnd. o mergency Lighting BatterV Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number ..................................................... Tons KW No. of Self-Contained 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 Eciuivalent No. of Water KWNo. Heaters of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: VO Attach additional detail if desired, or as required by the Inspector of Rres. Estimated Value of Electrical Wor . d 0 a -5 0 o /0 When required by municipal policy.) Work to Start: ! -1 b 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 coveafe is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Pr BOND ❑ OTHER ❑ (Specify:) I certify, under the sins and penalties of perjury, that the information on this application is true and compfete. FIRM NAME:. uJ L L G LIC. NO.: Licensee: L< y rk M ti r r-6 Signature LIC. NO.: (If applicable, enter "exempt" in the license nuInber line) U U OBus. Tel. No. - Address: 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 PERMIT FEE. $ � 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 y 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 0 Failed Ed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE CTION: 11,e Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: u Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com 9 t� The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): t't I�X) Cil V S I eC iY I L LLC Address: City/State/Zip: a k' I� M, C)t 9 3 0 Phone #: 0118)R7-0oa c) e q78)4ao "T"o Are you an employer? Check the appropriate box: Type of project (required): 1.dam a employer with •employees (full and/or part-time).* 7. ❑ New construction 2. ❑ I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity. [No workers' comp. insurance required.] 9. ❑ Demolition 3.❑ I am a homeowner doing all work myself. [No workers' compAnsurance required.] t 10 ❑ Bui mg addition 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11. lectrical repairs or additions proprietors with no employees. 12. E] Plumbing repairs or additions 5. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. ❑ I 13. ❑ Roof repairs These sub -contractors have employees and have workers' comp. insurance.# 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152, § 1(4), and we have no. employees. [No workers' 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 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. 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. Lie. #: Expiration Date: Job Site Address: —1 a 1 car 10" A Dr; V 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 MGL c. 152, §25A is a criminal violation punishable by 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. 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. 77-(37 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 oiliire, 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 1.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 may be 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' compensatiori'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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia +� i'_t"1MRltfllUtA/�1►1'1'I.M�f'1C `AAG��A/+ut1�+��rr�+ ' � w BOARD OF J'A ELECTRICIANS ISSUES THE FOLLOWING LICENSE AREGISTERED MASTER ELECTRICIA 'KIRK A MURRAY 26 TALMUTH AVE ` 14AVERHILL MA 01830-1421 t 21431 A 07131/16 32648 N° 1 712 .a .1 (1..- (1- � Date.... u. �C.. -7/577 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...l!F7�cG�t2 r e t /y n� ........................................................................... . r has permission to perform . ���? '...r...............�lg%�`- .............................. wiring in the,btilding of............Vs................ffi9;L....� ............................... 4- dYit oti ��� ✓�= at............................................................................... .North Andover, Mass. Fe...... Lic. No G.A............................................................ } ELECTRICAL INSPECTOR 06/15/99 14;34 WHITE: Applicant CANARY: Building Dept. POKOerreallft THEC0AW0NWE4LTH0FhflS34C 1 ` r7TS Office Use o�y DE'ARTA10VTOFPUBLICSAFE7Y Permit No. 1712— BOARD OFFMPREVE MONREGM770A.SR7CMR 12:00 U94 Occupancy &Fees Checked PPLICATIONFOR PERM[T TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the In ect of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant L` /} hip,2, a- Owner's Address Is this permit in conjunction with a building permit: Yes �.-�do (Check Appropriate Box) Purpose of Building --5//L /G ��/� y Utility Authorization No. Existing Service If Amps / ZYGVolts Overhead ®—Underground a No. of Meters New Service Amps / Volts Overhead Underground No. of Meters --�® Number of Feeders and Ampacity Lobation and Nature of Proposed Electrical Work ,tRF %/C ^l.-Qj � C/jle,��' No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA N�. of Lighting Fixtures Swimming Pool Above Below Generators KVA and1:1 round No. of Receptacle Outlets No. of Oil Burners No. 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 Disposals No. of Heat Total Total I Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW t No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW a Connections ® •No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER Laws • . w:. .I• • •r r • I til•• 9. - ff�cu hawdrdwd YES, •-r..`• I •Ir.rl ••• •• •bydxxiaEthe WC&ADSUI 1> 62 sn :• ValuedUednd Walk SigriedutxbS •" it/w • •: Rough FIRMNAPvE LimriseNTOL AIL TP -L -Mt. OWNER'SINSi1RANCEWAIVER;IamawaethattheL the amra=c"aworitsstksWnt ieq vakrtastt byMassadn CaulIam atdtvtnrysgntmar$ispmniTpfimtmv iAstimesm* siattem (Please check one) Owner ® Agent ED Telephone No. PERMIT FEE $ ���! r Location No. % % Date f NtiRT,, y -TOWN OF NORTH ANDOVER O�tt`•D_ !•h�0 .. 9 Certificate of Occupancy $ ' ',v �°•E<�' �ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ � TOTAL $ j' Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPA15 RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING z ��� .�a�°��w i�i�^T'i'�t�YxY�,r�, 'a;i� �''��' �.." _a � �9�'";T. • ; Sfi",..Y" vx�4 t"d"� ea ,zs :�'..MINE, .; BUILDING PERMIT NUMBER: DATE ISS D: SIGNATURE: Signature Telephone Building Commissioner/IEEeEtor of Buildings Dafe [�T /YTiA1T VL'V1LVl\ 1-•1JLar, 11\r Vil111A 11V1\ I 1.1 ✓✓,Property Address: 1.2 Assessors Map and Parcel Jaz Map Number Number: sd Parcel Number 1.3 Zoning Information: Zoning District Proposed Use Signature Telephone 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Name Print Address for Service: Signature Telephone Front Yard . Side Yard Rear Yard ReqWred Provide Required Provided Required Provided '���, I J ,• '� �!' ; License Number 1.7 Water Supply M.G.L.C.40. 54)_ ` Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ 0Jt%-11V1Nt - r.KVrV,K1 Y UW1VEKSk 1P/AUTHUKIlED AGENT 2.1 Owner of Record Name (Print) Address for Se is Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTFON 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: °�, '���, I J ,• '� �!' ; License Number A dress / �� �C, r%\r '� ;� ✓ Expiration Dae Signature . �; Telephone V 2 egstered Home Improvement, Contractor Not Applicable ❑ Company Name Registration Number Address ✓ `� Expiration Date Sign'a�tute Telephone • f . SECTION 4 - WORKERS COMPENSATION (nG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building a Repair(s) ❑ Alterations(s) 7iftion ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ! /L SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar) to be Dollar ( Co leted bpermit applicam� I. Building ©, (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) dp 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I,�%"� �!"� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief % // l 1f7d XIA /6 // Print Name Signature of Or/Agent ' NO. OF STORIES Date 7�— SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS iST 2ND 3 PM SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4 1 C/) C m C/) 0 m _v, y d �. W — -m CO) C'7 CD MZ y G.O n• ? O CL:q. y O v CDCL Pulp O Q d CD CD O CD ww C CD H �. v. v y —• o co CD Id n O z C� 9 0 0 01 = O -m n m n m0a� m Zy. CD .. c = °: O y '77 ,.. =a"'a m CD -4O y O y p O .,.= : o imm a m 0� 0 0 ozy:A n m 0 t6o Q O = _ `(A 0 COD C X0CD �yy CA CD 1�J � H � p O1 N CA cr3 \,J CA CD c "* CD ti = CO) H R .d►co o co0 C ' O O .-t O O O 0 O • z h CD O • oma: cn a 2 .. _ JA ;wdJ CD � So 0 = CD a M �( C-) c) 0 °: C0 1 CR O_ ` O 0 . -k . �°� �J o °= y ?? Crf Irl �'. ')d oda r ro "�7 w n o. C/) �^ y "rl rL dd �x �7 70 e 0 0 c CD I am a homeowner performing all worK myselr. F-:;�` I a -ad a sole proprietor and have no one working in any capacity 0 I am an employer providing workers' compensation for my employees working on this job. Company nameG�//rrL1 Z Cites 5 � Phone #: In,i-irancA Co_ 114LA-n10L 1Ah - POIICV # Com an name: i Address Ci : Phone #: of and/or one ears' im nsonment_as Drell..as_ciml.penalties in ihelam d a_S'ORWO Investigations DIA for al penalties ._a -da - up to $1,500 Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of cumin y ..p .. of.($100.00)�asiay.against.me. I understand that a copy of this statement may be forwarded to the Office of g coverage verification. a I do hereby certify under the�pains and penalties of pear' ry tqginformation provided above is true and correct. Print Official use only do not write in this area to be completed by city or town official' 55 City or Town Perm'it/Licensina ❑ Building Dept []check if immediate response is required .0 i'_icenSinq Board p Selectman's Office Contact person: Phone #: C] Health Department 11 Other M FarrOR Construction 'Farrell Construction Invoice 5 School St. 3/1/2001 Invoice # Salem, NH 03079 " Date 16 E -M. Westphalen 24 Marian Dr. No. Andover, Ma. 01845 Item Qty Description Amount Siding Cover entire house with Tyvek housewrap and 5,000.00 Quest (cedar grain texture) vinyl siding. Gutters Remove existing gutters and replace with seamless aluminum gutters Fascia and Sofit Cover all windows, doors, with aluminum fascia. 1,885.00 Drill holes and install vented sofit. Storm Door Install storm door and replace molding 275.00 Shutters Install 4 pairs of shutters and 3 new gable end 240.00 vents Thank you for your business. Total $7,400.00 Payments/Credits $0.00 Balance Due $7,400.00