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Home My WebLink AboutMiscellaneous - 25 ENGLISH CIRCLE 4/30/2018 (3)~ ❑ Way' t i i 14ORT4 14 O A x e � •x TOWN OF NORTH ANDOVER MASSACHUSETTS i BOARD OF APPEALS i Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA. on Tuesday the 9th day of June 1998, at 7:30 PM to all parties interested in the appeal of Jim & Jane Richard, 25 English Circle, No. Andover, as a party aggrieved for review of a decision made by the Building Inspector, or other authority, regarding Mass. General Law Ch. 40 s.6 and section (s) 9 and 10.11 of the North Andover Zoning Bylaw. Premises affected is building numbered 521 Salem St. in the R-3 Zoning District. Application is available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1. -PM. By Order of the Board of Appeals, William J. Sullivan, Chairman LEGAL NOTICE TOWN OF NORTH ANDOVER MASSACHUSETTS Published in the Eagle Tribune on 5/26/98 & 6/2/98 ' BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, /legalnov/3 345 a Andover , SMA, on Tuesday the 9th day of June, 1998, at P.M. to all parties interested in the appeal of Jim 8, Jane Richard, 25 English Circle, No. Andover, as a party aggrieved for review of a decision made by the Building Inspector, or other authority, regarding Mass. General Law Ch. .40 s.6and section (s) 9 and 10.11 of the North Andover Zoning Bylaw. Premises affected is build. ing numbered 521 Salem St. in the R-3 Zoning Dis- trict. Application is available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, -from the; hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, Chairman ET— May 26, June 2, 1998 S TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given that the Board of Appeals will hold a public hearing at the Steven's Memorial Library, 345 Main ,St., North Andover, MA. on Tuesday the 9th day of June 1998, at 7:30 PM to all parties interested in the appeal of Jim & Jane Richard, 25 English Circle, No. Andover, as a party aggrieved for review of a decision made by the Building Inspector, or other authority, regarding Mass. General Law Ch. 40 s.6 and section (s) 9 and 10.11 of the North Andover Zoning Bylaw. Premises affected is building numbered 521 Salem St. in the R-3 Zoning District. Application is available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, from the hours of 9:AM to 1:PM. By Order of the Board of Appeals, William J. Sullivan, Chairman Published in the Eagle Tribune on 5/26/98 & 6/2/98 /legalnov/3 r,. LE_ NOTICE TOWN OF , NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Notice is hereby given tha the Board of Appeals wil hold a Public hearing at the Steven's Memorial Library, 345 Main St., North Andover, MA, on Tuesday the 9th day of June, 1998, at 7:30 P.M. to all parties interested in the appeal of Jim & Jane Richard, 25 English Circle, No. Andover, as a party aggrieved for. review of a decision made by the Building Inspector, or other authority, regarding Mass. General Law Ch. 40 s.6 and section (s) 9 and 10.11 of the North Andover Zoning Bylaw. Premises affected is build- ing numbered 521 Salem St. trix. in the R-3 Zoning Dis- Application is available for review at the Office of the Building Dept., Town Hall, 120 Main Street, Monday through Thursday, -from the. hours of 9:AM to 1:PM. By Order of the Board of Appeals William J. Sullivan, ET— May 26, June 2at 99rma8 a; Date ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION E614�3e CUkA- This certifies that ................ ..................... ..... .................... .............. ................ ....... has permission for gaj�stallation ....... ...... . ........ ... .......... A - "T 1 in the buildings of ................. ez, . .................................................................................................. at ....2.5, . ......... . North Andover, Mass. Fee.50 . . ....... L i c. No. - 27 -` ? 3.. M 6-� ........................................................... GASINSPECTOR C --I I �e Check # U 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY b , �v.,�a MA DATE • 23 — i 5 PERMIT # ._ - JOBSITE ADDRESS2 _ _ �� I��1�. L'�� OWNER'S NAME GOWNER ADDRESS I TEL0—L133T FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL Ej EDUCATIONAL ® RESIDENTIAL 09 CLEARLY NEW: [ RENOVATION: REPLACEMENT: El PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER --. _:D =......LL. I .. I l.. __ - . :l 1. - _ . ._ BOOSTER !::j E--1 .._.-- h- E:— CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER` FIREPLACE) �,. �_ I 1 1 —! .... . --! FRYOLATOR - - -:j _ _ FURNACE GENERATOR GRILLE INFRARED HEATERS LABORATORY COCKS.I— MAKEUP AIR ;UNIT _ OVEN POOL HEATER ROOM / SPACE HEATER_! I+! ROOF TOP UNIT TEST? I —! UNIT HEATER' UNVE�TED ROOM HEATER WATER HEATER OTHER I y — INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES ONO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. I CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and acct]i-ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co lance wA all Perti a provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �1M, — LICENSE# SIMATURE MP EJ MGF JP 2j JGF 0 LPGI Eil CORPORATION []# = PARTNERSHIP ®#� __�( LLC D# � COMPANY NAME: 1 PI s�w1�u--JIADDRESS CITY STATE �ZIP TEL FAX -,5714,q CELL bo _ 9 -/fad EMAIL ^ - „V.�� o PV o . ' o H m -i = RI .. Cl) � D v r_ ' n � NCl) m Old c O �i m trJ � s t%°J z �* -mo y m O HO � � O Gn El N O E O ro n O• z P `Y The Commonwealth of Massachusetts Department of IndustriqlAccidiiks Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual): __Y01?, l 9 �� Address: City/State/Zip: 395:s�� , �� a3VtS Phone#: 603 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 employees (full and/or part-time).* 2. ®•I am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. t 7. E] Remodeling ship and'have no employees These sub -contractors have 8. ❑Demolition working for metin any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its ME] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL I L ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] employees. [No workers' 13.1-1 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they ice doing all work and then hire outside contractors must submit a new 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N 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 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. Ido hereby ert .on depthe pains-snd penalties ofperjury that flee information provided above is true and correct. 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 2.1 Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone Informati®n 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 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 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 numbers) along with their certificates) 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' 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 orITown 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. Iu 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. I 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 GommonweaXtb o£Massachusetts Department ofIndustdal Accidents Office ofInvestigations 600 Washington Slxeet Boston, U. 02111 Tel, # 617727-4900 ext 406 or 1-877-M SSAFE Revised 5-26-05 hay, # 617-727-7749 w`�w.zx�ass,govfdxa i i Date.............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 6 1 e ve-pAal cpc:.L � C--�ZA e-- t I .................................................... ............................................................ has permission to perform2ulVT�OtAe/DA(,-4 e->. .............................................. ie .................................. ...... ........... wiring in the building of.......i`1..: .................................................................. A# at .. . ............. /19)4h Andover, Mas ......................................... . . ............................................. 7 . .. .... ..........Pe.................... Lic. No .......... ................... .......... ...... ELECTRICAL INSPECTOR I , L) I -w -D Check . -, r f N n .r lc\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. _h a Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] eaveblank I 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: 1/22/15 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) 25 English Circle Owner or Tenant Jane Richard Telephone No. 978-697-2933 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Dwelling Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ i Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install 20A Arc Fault Circuit &Outlet For Gas Fireplace Insert. Replace 3 Smoke Alarms With Smoke & Carbon Monoxide Combo Alarms Comnletinn ofthe follnwinQ table may he waived by the In.cnertnr nfWirec 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 Luminaires Swimming Pool Above E-] In- E] rnd. rnd. No. o Emergency Lighting Battery Units No. of Receptacle Outlets 1 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 g No. of Waste Disposers No. Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alertin 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 Heaters No. 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 OTHiR: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $915 (When required by municipal policy.) Work to Start: 1/22/15 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: Steven M Parker Electric LLC Licensee: Steven M Parker Signature__ (If applicable, enter "exempt" in the license number line) Bus. Address: 633 Riverside Avenue Unit 8 Haverhill, MA. 01830 LIC. NO.: 21502-A LIC. NO.: 12903-B Tel. No.: 1-978-360-9592 Alt. Tel. No.: 1-978-918-1004 *Security System Contractor License required for this work; if applicable, enter the license number here: 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. I O„,COMMONWEALTH The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): STEVEN M. PARKER ELECTRIC Address:633 RIVERSIDE AVE APT 8 .HAVERHILL, MA. 01830 Phone #:978'360-9592 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors �. ✓❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' rNo workers' comn_ insurance comp. msurance.t required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reQuired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. Electrical repairs or additions I1.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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-dontractors 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. Lic. #: Expiration Date: Job Site Address:All Locations In The Town Of North Andover, MA. 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 an4.penalties of perjury that the information provided above is true and correct. Phone #:978-360-9592 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 #•