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HomeMy WebLinkAboutMiscellaneous - 257 BRIDLE PATH 4/30/2018N a. r 06/15/06 16:02 FAX 978 474 0148 PARK STREET, TRAVEL North Anda�er Hea! h de artent 1600 Osgood Street Building 20, Suite 2.36 North Andover, MA 01845 978,688.9540 - Phone 978.688.9476 r- Fax head tewnafmMiandover,cem • lanai{ Letter of Transmittal FP7cge . of 2001 PAGE 01/03 00 W,. are sending you: O Cop/ of Letter D Plans © Other (fill in belsw) These are transmitted as cbetked below: ➢ 04pnraalasA d awe Dash Ward ➢ (]tri* a mkfore t �? 4 �c D yrw�gaord ➢ Drarawkw relaxtsn W COPY T0: MAL I E Drrra rib Ward ➢ (]tri* a mkfore t �? 4 �c D COPY T0: COPY T0: MAL I E 516NED: ' COPY i0: ail? S 4/0 / D well�j r 06/15/06 16:02 FAX 978 474 0148 PARR STREET.TRAVEL .. �va.�v 4�• J'T y �" vvT i Y 7 NorFiAnda_rmer Health dega�e"t 1604 p$good Street Building 20, Suite 2-36 North Andover.. MA 01845 979.688.9540 - Phalle 978.688.8476 r- Fax 1,aeltltd®_ �_ o�tnwnofr�ortf+andbver e, em • E-ntai{ www.jo—wndnoakmdovar.mm Website UPM: Phone: �1«gals/ F& rtr-fM-rM Letter of Transmittal Page of DATE: Flog: Pm/ la Get We are sending you: O Copy of Le#er L7 Plans O other (ltll in helm) These are transmitted as checked below: ➢ >ylbr4lmd A ➢ z7fira4wadomaw > Dash ➢ DFarnkri(m U001 PAGE 01/03 p C m*fr WVW A L7&" a{a Kfworat RFfdAQICS: � j COPY T0: COPY TO: S10NED_ r COPY TO: CL OzIe_ -S off 71 ,"A i' � �% GUS 06/15/06 16:02 FAX 978 474 0148 . PARK STREET TRAVEL 0 002 — � — -- -- rout a'LIl�� BEAVER OR MUSICRAT CONSBNX' IFORM consent.For I give permission for to access my property for the purpose of alleviating a threMt to publie health and wkly posed �Ybe�ver or >znaslaat, as dctermkC4 by the Board of 9 eT_� �_ _ �,�..... Date !1 .A,ddres5 ` Daytime Tcl, � Conscut Form I give pern"On dor purpose alleviating a tbrW t U1 beahh ar det the Board of eabt'b. i at&e ofPro 221 Dgtitne Tel. # 47 SF 6s'i �i61 — to access lay property for the posed by beaver or mnSIM4 as 6// Z(S D4-1�•m Consent Forte I give ' ion for to access ltty property for the purpose o alleviating a threat t blit h th and sa ft posed by beam or muskrat, as det by the Board i Si of Prq&R&wner /7 Date C." bawmenUNAnimpMWI%aEAVMFORMS OCT 2001%mvwCww%r =A= 06/15/06 16:02 FAX 978 474 0148 PARK STREET TRAVEL - �-• _- ICHL 11 1 M ssaclhusetts Beaver Law Flaw Chest Arc you incurring gbeaver darne�e may be a tbrcac tca,pUbliC health under 1'a -i" in beaver la+v ront►td Io1� l for pomhtc emergency permit p4tmit denied 10 -day erttorgeney pamitissued ProblcW solved still not solved Apply to pFW for 30 -day xtcnsion permit using A$ B and/dr C Permit appmved� 3 1 1 to 130E for You may apply additional 10-4y emergency permit 30 -day permit approve! I"ay permlt becomes void You mast develop with DFW, BOH sttd Conservation commission, a long-4crm managaiMlt plan "ans A any box. oW or eombear type U" B breach iflg of darns C Installation of water flow devioas B & C require COriCam approval No You may appeal to DPH warding public health quastlons or DFW rcgording vAldlift cause. Appy approved [a 003 HAUh 53/03 Contact DM far possible non. emergency permit appeal denied ,`` �V9LI�ng SOK ^d RIlt you may -apply to ROH for 2nd additional emergency penult -option B and/or C Only Boll- Board of Health DIM ® Dlvigi6h of Fisheries & Wildlife DPH 9 Department of Public Heath 06/15/06 16:02 FAX 978 474 0148 North A dover weaith De art e I 1600 Osgood Street Building 20, suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax he Ithde a o a dover.tom - E-mail WWW.t6Wn0%6rthpnd0yer.ca - Wehsite PARK STREET TRAVEL 2004 r -AGE 01/03 Letter of Transmittal Ea -9e of s.►cwus We are senAft you. D Copy offefter V Plops QOther frill in halowf These are transmuted as checked below: ➢��,gre►4rAbd > o� )�' l7iar47md mmxd ➢ n W*farAW. RMAIKS_ COPY S0: COPY T0: SIGNW: COPY TD; 06/15/06 16:08 FAX 978 474 0148 PARK STREET TRAVEL 8005 rAt- 172/ P13 "PlIOATION FOR j0 -DAY EMERGENCY PST TO MANAGE ]BEAVER OR MUSIGUT TEMAT To BE HUED OUT BY APPLICANT Fee (if applicable): $ Nam; /Date: d At Agent Name: (ifappWWe) Tel. # Complaint Location: Is the problem entirely on yo» property? Yes: No: Don't Know: Note: If the probiemt does not occur entirely on the applicant's propmty, coxisent forms fmmi all other property owners must be off. COMPlaint COudition; Check appropriate box and pr vj& a dctailed description of ffic perceived tbreat to public bean and safety ❑ Floo&g of difiik ng. water well ❑ Floodi V of septic system oar sewer ❑ Flooding of public or private way or driveway ❑ 1~loodiAg of a utility structure such As an electTical or communications facility ❑ Flooding of as buOding 0'WV V0QMQncsl,/ 1M01RW011Bl=ver10171fty &n-P"YP-wi doc SS/aem 06/15/06 16:03 FAX 978 474 0148 PARR STREET TRAVEL ❑ Flooding poses h minent tbred of substatial property damage wbilcb, prevents nozznalagrienhozal use of land e • * a ZMARM- PI - 2006 r H47C GJ! ejj r Under 1V G.L. c. 131, s. 80A, an emergea py permit authorizes the applies or his duly authorized agent to i r mediately iemedy the threat to buman health and safety by one or more of the following options: (a) the use of Comlxmr or box or cage type traps for the taking of beaver or Inuslerat, subject to rcgalations; (b) the 'breaching of dams, dikes, bogs or berms; and/or (c) employing any non letbak,amnage=t of water flow devices. The emergeay pmt wM be good for 10 days from the date of issue. I certify the above informatio is true and r t too the best of my lutowl�edge Sigusture of Applicant: Ddte: C� 'llWS SEMON IS FOR cowLETION By NORTH ANDovEIt=AnTH AND coNsERVAnON bWARTmEm Site visit by Health: Date _ Inspector DMM: ,A,ppmved PeCmit # Start Date Permit Denied Snd Date Ext. Date_ Date Director S%natm Site visit by Conservation: Date _ Inspector name: Conservation Commission Application Required: Yes- ._ - Na Findings & recoolw=dataans: /,Tote; Options (b) and/or (c) above require applicant to get North Andover Conservation Commission approval prior to such work in accordance with the Wetlmd$ P�oteotlon Act, C-,Wy Dom"=WAnimala12001',Pervet FomtAAppli=6tm fw lODay Emagef oy h mfi.dm SS/Wm 1p 6262 This certifies that ....... Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING haspermission to perform ......................................... I ....................................... wiring in the building of *,At .... .................... .......................................... at ...... ... .... . ....... ........ . North Andover, Mass. ice .A Fee. ........ Lic. No:`./ >../! /I.....................✓;: ................... ELECTRICAL INSPECTOR V �Check # �rl\ Commonwealth of Massachusetts Official Use Only mmm-- Permit No. 4,--g6 , Department of Fire Services Occupancy and Fee Checked"—� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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 PRI/VT LV IlVK OR TY L LVFOR11MTIOIV) Date: la� 4 —41-95 City or Town of:.A10d VFC(L-- To the Inspector of !'Vires: By this application the undersigned gives notice of his or her intend perform the electrical work described below. Location (Street &Number) Owner or Tenant ��� tj��� (Z Telephone NoJM00 -3 Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Yes ❑ No (Check Appropriate Box) Utility Aluthorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of (Meters AJ D I - Completion of the following 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 Luminaires Above ❑ In- ❑ Swimming Pool grnd. zrnd. t o. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners of Detection and No. InitiatingDevices No. of Ranges g No. of Air Cond. Total Tons ng No. of AlertiDevices b No. of Waste Disposers Heat Pum I.Number Tons KW No. of Self -Contained 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 E uivalent No. Hvdromassage Bathtubs No. of Motors Total HP Teiecommuttications 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:, (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:) / certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM "TAME: ADT Security Services, Inc. LIC. NO.: 1533 C Licensee: Signatur (if applicable, c' ter "exempt" in the license number line.) Bus. Tel. No.: 603-194-5900 Address: 18 Clinton Drive Hollis N.H. 03049 Alt. Tel. No.: 603-594-1930 *Security System Contractor License required for this work; if applicable, enter the license number here: SS Cr--- c,e: i "- 3 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 anent. Owner/Agent FPERMIT FEE: S �� Signature Telephone No. Date. //-Z!/:.4 .'. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. has permission to perform ... ��.�..'.� r plumbing in the buildings of .. '', �' (�.+.�................... . • • .... North Andover, Mass. Fee. . a �... Lic. No. ? L . ........... _....... 1PLUMBING INSPECTOR M Check # 1 5022 (Type or Print) NORTH ANDOVER 3„Building Location 6w _... r.iwwl �y Data: PxrjWl I Ja2Z L' Own&s"N, Renovation Replacement [j Plans Sybmitted ❑ '� r�vr��r�r—cam • SUB-nBSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 6TH FLOOR 6TH FLOOR 7TKFLOOR eTHFLOOR (Print or Type): Installing Company Nam( Address =10 I I i I I i r I I r I 1 r r. �� rl Ch ck one: Certifi to Lev Corp. Partner. FirmlCo_ Business Telephone��� 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 Li Insurance Waiver: I, th undersigned, have been made aware - that the licensee of i this application does not have any one of the above three insurance coverages. Signature of ownerlagent of property Owner Agents. I bcreby certify that all of tine dcuil& and in(osmalion 16a.c subin illcd (or cnlcrcd) in &Mage amiralioo are lore aN�Ware to doe best r w k"wkdge and lbat all plumbing work and installations I►er(ornicd undcr rcrmil 1%sucd for this applic74ion will be inca ej{b W �tbltM tyiooa stf tbs Maas mulcts Slue Plumbiai Cad and C7uplct 142 of Ific (:cnu&1 La{. r V By Title City/Town: .ADDQ0VFr) 7oFFICF USE ONLY1 Signature of Licensed Plumber Type of Plumbing License License Number ❑ Mastle Journeya" Z ' N W O J 6a W Y — A Z W Zic U W .. O <_ y J Qs p a r m <rJ J 1- a a la03 o 0 P. W i¢ m < N 0 ori W O N 0 N ?c #- = D J 2 O U< U <~ S Y W Q = on N W X z l• X z v1 4 o N 4f < Q G 0 Q W on 4 k. 0 O on J= x O < O tt Q X X o d - <_<� X 0. 0 < W w t- < • 4 z 0. C J k. V. X o U= C o W I= I- X W 0 SUB-nBSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 6TH FLOOR 6TH FLOOR 7TKFLOOR eTHFLOOR (Print or Type): Installing Company Nam( Address =10 I I i I I i r I I r I 1 r r. �� rl Ch ck one: Certifi to Lev Corp. Partner. FirmlCo_ Business Telephone��� 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 Li Insurance Waiver: I, th undersigned, have been made aware - that the licensee of i this application does not have any one of the above three insurance coverages. Signature of ownerlagent of property Owner Agents. I bcreby certify that all of tine dcuil& and in(osmalion 16a.c subin illcd (or cnlcrcd) in &Mage amiralioo are lore aN�Ware to doe best r w k"wkdge and lbat all plumbing work and installations I►er(ornicd undcr rcrmil 1%sucd for this applic74ion will be inca ej{b W �tbltM tyiooa stf tbs Maas mulcts Slue Plumbiai Cad and C7uplct 142 of Ific (:cnu&1 La{. r V By Title City/Town: .ADDQ0VFr) 7oFFICF USE ONLY1 Signature of Licensed Plumber Type of Plumbing License License Number ❑ Mastle Journeya" N2 346-3 Date...... f ..�1`.......v� TOWN OF NORTH ANDOVER CL PERMIT FOR WIRING This certifies that .......:.:.:. f ............................................../................................. has permission to perform............ ` e'' ° �`� ............................................................................... wiring in the building of ........... at A 7 �r.�.�...:. ...fJr.f �? North Andover Mass./ $ Fee.D.10... Lic. No.� . ,.. ......-...... .... .....:...�'/ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THECl0M11ONWF9LTHOFMAMCHUS= office use only DEPARTAfENTOFPUBLICSAFM Permit No. BOARD 0FMEPREVEW0ArRWUAT101 N5r(MR12-00 VA Occupancy &Fees Checked FORRPERMIT 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 1 t! Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 2, % 13rAll e Pl;plh Owner or Tenant 0&,/ l It P Owner's Address /'77 e Is this permit in conjuncti�o"n' with a building permit: Yes ✓ No Purpose of Building Existing Service A) Amps /� Volts Overhead New Service Amps Volts Overhead M Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. Underground No. of Meters / r.� Underground No. of Meters No.'bfLighting OutletsG No. of Hot Tubs No. of Transformers Total KVA No,,, f Lighting Fixtures Swimming Pool Above ground 1:1ound Below Generators KVA No. of Receptacle Outlets t— J No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local Municipal Connections No. of Zones a Other No. of Ranges / / No. of Air Cond. Total�l Tons 3 No. of Disposals / No. of Heat Total Total Pumps Tons KW No. of Dishwashers 22- Space Area Heating KW No. of Dryers / Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- 2 b Oh i?uvm� k Bch rl? , % c -dl? Pa m. L /7g4 iP il ; APIA hist a =Cmeragg lam IhaveaaraatLmWkarmxPblitymdudmgCa Vide CoAmWaAsskstFtdogtnvale3d YES = NO IhaNeWmi adva6dptocfofsainebtheOffm YESff}tar.ha%edvdWYES,pimemdc*thetypeofWVWdWbycl�tgthe CE[a BOND � OZI &R" . a ftmSpaffy) FstirrWdVa9a dUechiral Wodc $ WorkmSwt —v l InspedunDtAeReWe ted Rottgh �•/!l ('tel/ Final iy/ sigrtedtarder�iePofpajtay: . FIRMNAME u=isce Sigrow Lio�eNo / �Bttsirle<ssTelNa �G�•��`rj S6y�. A/// Org AItTd.Na OWNER'SMJRANCEWAIVER;IamawaretrtftLkm nutt theit%==omVans le*rAatasmgLmmWbyMaadasMGarrALmvs andthatmysigtrtseort mp=*Wplicaba►wai«sthismquaetrat. (Please check one) Owner Agent . Telephone No. PERMIT FEE $ Date. I...... •e.^YO TOWN OF NORTH ANDOVER to A PERMIT FOR GAS INSTALLATION This certifies that ... f. ! ..�:%'.' . ! has permission for gas installation ........ in the buildings of ...l` :.'. !. !. !.......................... . at ..? . ? ..?.. �' �' ' . :.!�!...l ....... . , North Andover, Mass. Fee..S.-?Lic. No..J'.: �.. �... ........... GAS INSPECTOR Check # / .' , 335 Owner's Name New)�( Renovation ❑ Replacement ❑ AS G Permit # Amount $ Plans Submitted ❑ (Print or Name of Licensed Plumber or Gas Fitter jChec one: Certifi a Installing Company Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGEeck on . I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked }_es, please grdicate the type coverage by checking the appropriate b 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true ana accurate to me best of my knowledge and that all plumbing work and installatio performed under Pe i ssued this application will be in compliance with all pertinent provisions of the Maschusetts,lOe Gas Code and C ft General Law By: Signature of 1 Title ❑ Plumber City/Town ❑ Gas Fitter Vumeyman aster APPROVED (OFFICE USE ONLY) seg Pldmber Or Gas Fitter 1 erase Mum er z c e o a z�a z w d O O F fZ w d W z a p a > w w w v, m w z a x x a w � w C7 F z F E• Ew W Y C7 n O > Z w C Z C w z d W w > r� W ] z x -t pa O 0 W C O n w F x C t7 x w r C U U x > A a F O SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOGR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or Name of Licensed Plumber or Gas Fitter jChec one: Certifi a Installing Company Corp. ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGEeck on . I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ If you have checked }_es, please grdicate the type coverage by checking the appropriate b 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true ana accurate to me best of my knowledge and that all plumbing work and installatio performed under Pe i ssued this application will be in compliance with all pertinent provisions of the Maschusetts,lOe Gas Code and C ft General Law By: Signature of 1 Title ❑ Plumber City/Town ❑ Gas Fitter Vumeyman aster APPROVED (OFFICE USE ONLY) seg Pldmber Or Gas Fitter 1 erase Mum er *2 2 70 J Date ...1.........hz i TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �` J G • 1i �..00 /2 ............................................................................ has permission to perform ..... .................... �/(�F 2 wtnr►g m the building of ........... .....e .................................................................. ' at ............. North Andover, Mass. 5..7........! .I?.:..A.. �9—t ... Fee.. . S..'..J. Lic. No. 1,r ........... r ^.:.:.... %?'..................... ELECMCAL INSPECTOR Check # { WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,a N THE MMMUNWEALIHUPMAr5i.MHUSKIIN Utnce Use only DEPARTMENTOFPUBIKSAFM Permit No. t -7,9"3/ BOARD OFMEPREVEMONRWMTIOI N527CMR12:00 UVA Occupancy &Fees CheckedPPLICATIONFOR PERMIT 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) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) r7 dl -1-4u . tl Owner or Tenant bA U ) i) A- C,e'r, Owner's Address 's;I\>Yi 9 Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building of — L I Yo Utility Authorization No. Existing Service Amps/ ^ Volts Overhead Underground M No. of Meters New Service Amps----- Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work' T(f 6(1d�6,9� c-T-itl� i°aS�" / 6 /,/t` e- 7- Rii. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA V grounda1:1round 17 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 Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Other I No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• l sutaooeCo Aasm tiDthetegt»artetsoftvmdts&Gax ALaws IhawaamatLabttUyh&m=PobyutdudnngC qkk Cove-agecritsegtuva YES NO IhmsuW1&dvandptoofofsame1DtheOffm YES M NO M If}cutmetfta WYES,pkasemdi*thetyWcifmcraWbydtaimgthe WSURAT bcDLT✓ 0-- BOND OTHER M (PleaseSpeafy) Eshrt>aled Value ical Wads $ Work ID SWt lepirspadrn Date Requested Rough Fatal Signed unda-M Nnalks of_pa�tay FIRM NAME E "1� � �/AT✓'4 � L ceseNa Lic=, 56"t, lb C ! 7 l oZ A&6,, 200 ELSYl Sr' f)0 . N'60Uu l (1c,ck Alt. TeLNb. OWNER'S 1NSURANCEWANER;Iamay.-mlhAdrLxwmdmnut theitstaameoo ortlsst>)�star>tral astegtmadbyM�adast Gaterallaws andthatmyQgt�taernthis patt�ralwa�fhis tagtaBanalt. (Please check one) Owner Agent \Uk-,e d-5 wd Telephone No. PERMIT FEE $ 10-40 &y dl) ,a Id ash d� FORM U - LOT RELEASE FORM y INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. %*"*"******* **************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANMAI TING PHONE_ X037 97t �f�2-338a LOCATION: Assessor's Map Number PARCEL_? SUBDIVISION LOT (S) STREET SIO p_ ,� ST. NUMBER ZS7 OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: t.VN CKVA I JUN ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS COMMENTS 12 FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED -)///h/ -- DATE APPROVED DATE REJECTED DATE APPROVED / DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm o oAq i%04 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 17 Application by the undersigned is hereby made to connect with the town sewer main in _ Street, subject to the rules and regulations of the Division of Public Works. l Theremises are known as No.��` l �i / �X r Street or subdivision lot no. Owner _ Contractor Address Address Applicant's Signature 27 JL, - 1,5 f PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date By See back for rules and regulations F Hf;AL'�A . _ Street Division of Public Works .......... ......... Date ..... �/. 0 5 ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ....... f v............................. 1� ............................................................ has permission to perform ............. —71�1 . . ............. : ......... f ................................... . y. wiringin the building ---o ................... �t ..... .................................................................. at ........ ..... ........................... .... ........................ . North Andover, Mass. Fee.../..... . ............... .Lic. No. ............. .................................................................................... Check # ELECTRICAL INSPECTOR J u J,. Q \ � Commonwealth of Massachusetts o Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. b 6 Occupancy and Fee Checked Zev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the a sachusetts Electrical Code ), 5 C 12.00 LEASE PRINT ININK OR TYPE ALL INFORMATION Date:51 City or Town of: NORTH ANDOVER To the Inspector f Wires: By this application the undersigned gives notice of his or he intentiontoperform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. Yes ❑ No 0 (Check Appropriate Box) Utility Au horization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters <7 1r IV Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: (Paddle) Fans v Total TransSusp. Trsformers K'VA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires E]o. Swimming Pool Above F1In- rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Disposers p Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection No. of Dryers Y Heating Appliances KW Security Systems:'' No. of Devices or E uivalent No. of Water KW No. of No. of Data Wiring: Heaters 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 tvtres. 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA=NCE ❑ BOND ❑ OTHER ❑ (Specify:) IYcertify, under the aim a d penalties f er* ry, that the information on this application is true and complete. 1•IRM NAME:. AA/rIV-tr- LIC. NO.: Licensee: t V-e�r\ Signature LTC. NO.: f/1Xk (Ilapplicable to "exemp : t" in the 1 cense numbe ine.)ALIA Bus. Tel. No.: 6a3 913 7 9a l AddressOX 6 �� n, ' � ' �1� � I Alt. Tel. No.: A,03 S' L 22 *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 IPERMIT 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 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 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: - FINAL INSPECTIO b;. Pass M V1111, Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: G>�� Date: Z i SDE` OLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com Li The Commonwealth of Massachusetts Department of IndiustrialAceldents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia Compensation insurance Affidavit: Builders/Contractors/Electricians/l'lumbers. TO BE FILED WITH THE PERM'T'9NG •A ORO_ Name (Business/Oigariization/Individual): Address: r l Nil CitylState/Zip: fiLerl IY��Ci'� t'/' Phone #; Are you an employer? Check the appropriate box: 1.❑ I am a employer with employees (full and/or pari -time).* 2.❑ I am a sole proprietor or partnership and have no employees Working forme in any capacity. [No workers' comp. insurance required] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 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 proprietors with no employees. 5.F] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.' 6.Q 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.] a Type of project (required): 7. [1 N6Abnsirnct10n 8. E] R.emodeliiig 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12,0.plumbng repairs or additions 13•. [] Roof repairs 14.n Other *Any applicant that checks box i#1 must also fill out the section below showing their workers' compensation policy information: i Homeowners who submit this affidavit indicating they aze 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 state whether or not those entities, have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. a I am an employer that is providingworkers' 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--------- m Attach a copy of the workers' copepsation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required underMGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 enalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a and/or one-year imprisonment, as well as civil p be forwarded to the Office of Investigations of the DIA for insurance day against the violator. A copy of this statement may coverage verification. Ido hereby certify under tlzepains andpenalties ofperjury that the in provided move is true and correct. Date: Si ature: Official use only. Do not write in this area, to be completed by city or town of 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 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 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 enferpri'se, and including the legal representatives of a deceased employer, or the receivefor trustee 6f 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 b6 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 ofthis 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 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 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 pennit/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-AIASS.AFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia GENERATOR APPLICATION DATE: LOCATION: 61S,7 RY`i OWNERS NAME: I lt� GENERATOR kw 4 NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: CCTRICALECTRICAL RESIDENTIAL 03 GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: S��- A�IotY"\ *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL ro � Cµ EA DW 116 19 DOWNSPOUT DRAINS / 112- 110 j / / `` Al FS8�RAIN 110 114 \ \ \`i i I ! LIMIT/ OF WC I I1 i 118 120 � col + o A1A