HomeMy WebLinkAboutMiscellaneous - 278 BARKER STREET 4/30/2018-MR
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Town of Nol th Andover
D.B.A. — Zoning Compliance Form
978-688-9545
This form must be reviewed with the Inspector of Buildings.
Office Hours are Monday -Friday 8- 10 am, and 1-2 pm Monday -Thursday.
M = 20 M&WO I 15� M
Addres's of Business: S�fee_�— Zoning District Q2 -
Map
D(DI Lot bu_e)
Phonelj:e -t I 8�q —+ Email Qf'K'0biekrSV; �Q6malf(6m
Nature
Do you own this property? Yes X No
If no, written permission is required fi-om your landlord.
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 K
Description of Business Activity (Must be Completed)
0 04 ofw_ ve-IA"Lit FrV fne" r -y v no eqo1u,(f_cs
Signature of Applicant
For Signage Refer to North Andover Zoning Bylaw Section 6
The propos d-imj is an e u s zoning district.
S
Issued Bvlq
.1
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 (25) 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 residential use within the neighborhood;
g. Any such building shall include no features of design not customarily in buildings for residential
us
X;
S_ iVatu re Date/
Date..7/?.�/�:�7 ............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that 2)(�2C3,) al. Zpr-,j
has peftnission toperforfn.?�P,0"�,i
wiring in the building of ................. A�64/ ex, -s /c,
.............................................................................................
at /11-1 to -'W -
...... 4 ....................................... ;�� ........ rt A dovd, Mass.
Fee ... �25 ... . ......... Lic. Noo
............ E�CTRICA INSPECTOR
Check# hql I
/lid
Commonwealth of Massachusetts -
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
0ificial Use OnlY
Permit No. I T 15 1 (4 t
occupancy and Fee Checked
tev. 1/071 (leave blan�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perforined in accordance with the Massachusetts Electrical Code (IYMC), 527 CMR 12.00
(PLEASE PRTNTINNK OR YTTEALL MFORMHON) Date: - NZ V I;? OJ3
City or Town of. NORTH ANDOVER To thiln—sp-ector Wes:
Of
By this application,�e undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)_ c�71? 9AP&I-1 —M
Owner or Tenant
Owner's Address
Telephone
Is this permit in* conjunction with a building permit? Yes E] No Eq"' (Check Appropriate Box)
Purpose of Building Util't Authorization No.
- Existing Service Ido Amps /2 0 IdY0 Volts Overhead Undgrd [J No. of Meters
New Service /00 Amps 4RO 1,o2f(9 Volts Overhead UndgrdE] No. of Meters
Number of Feeders and Ampacity
Location and N
-7
W-9
of Proposed Electrical Work: AVIV 001#60J��^110P Alirej' 01'4 --
6A -k tur) Ale &/ wilj�j, e eLl" 14d9e Merl, -76e 7. &V?Ta?
lCompletion ofthefollowin table maybe 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
Swimming Pool Above Ei In- 0
grnd. grnd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS IN'o. of Zones
No. of Detection and
No. of Switches
No. of G2s Burners
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
Heat
Number
I Tons
I KW
No. of Self -Contained
No. of Waste Disposers
Tpout am, s�
I ...........................
I .........................
I .......................
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local E] Municippl El 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 Equivalent
No. Hydromassage Bathtubs
No. of Motors Total 12
Telecommunications Wiring:
No. of Devices or Eauivalent
OTHER:
Attach additional detail i(desired, or as required by the Inspector oi wires.
Estimated Value of ectrical Work: (When required by municipal policy.)
11
Work to Start: i)--12- L/J/,�- Inspections to be requested in accordance with 1�IEC Rule 10, and upon completion.
INSURANCE 66—VE—VAGE: nless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operatioif '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.
CBECK ONE: INSUIRANCE V BONDEI OTHEREJ (Specify:)
Icertify, tin(leriliepainsandpenaltiesofperjury, thattheinforniation on this application is true and complete.
FIRM NAME: YJ LIC. NO.:
LIC. NO.:,;�-47,� fC
Licensee: Signature-,,&& ,
(Yapplicable, enter "exempt" in the license number line) 10,6� Bus. Tel. No. -
Address: �a2 #eAl K &Af� - OW44r2�� 114-4- Q(9W Alt. Tel. No.:Ml�z
*Per M.G.L c. 147" -S. 57-61, se�tirity worYi6�ifirers Department offlublic, Safety "S" License: Lic. No. —
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
requiredbylaw. By my signature below, I hereby waive this requirement. I amthe (check one)EI owner El owner's agent.
Owner/Agent PEPRMIT FEE: $
Signature Telephone No. I
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 in -valid 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.
0 Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0
0 Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass R
Failed
Re- Inspection Required ($.) El
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass N
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
PARTLU ROUGH INSPECTION:
Pass R?
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) 0
Inspectors Comments:
Inspectors Siggature:
Date:
FINAL lNeEkTION:
Pass M V
Failed
Re- Inspection Required ($.) 0
Inspectors Comments:
41 44
4 !1 1
Inspectors Signature: Z&&11
/__
Date: 9 —/Y -/-S
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
I f
The Commonwealth of Massachusetts
Department ofIndustrialAccidents
I Congress street, S�Ite 100
Boston, AM 02114-2017
www.mass.gov1dia actors/Ele�tflcians/P]Wbers.
Vvarkers, Compensation Insurance Affidavit: Builders;/Conft
TO BE FILED WITH THE PF-RMTTIII�G AUTh[ORITY. Please.t1jRLLL2egdj!b1
Y
rmation
Name, (Business/Organizat'on&dvdual).—PA�w�
Address: d�d
CitylState/Zip: _1P
Are you an emp!oyer? C1
W,
tfie appropriate box:
� (SW Phone #:
oyees (fall and/or part-tirne).*
ifl I am a employer with mpl vVorking for mein
2. V,am a sole proprietor or partnership and have no employees
[No workers, comp. insurance required-]
any capacity. [Noworkers, comp. insurance required]
3.0 1 am ahomeowner doing all WOrkmy"lf
4.n I am a homeowner and will be hiring contractors to conduct all work on my property. 1will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no bQpm�e6�s.
5.FJ I am a general contract . or and I have hired the sub -contractors listed on the, attached sheet.
These sub -contractors hav6 e#loyees and have workers7 comp. insurance.T
6.FJ We are a corporatigii and its. offic6rs,have exercised their right of bxemption per MGL c.
1� �nrpl ' ' . [No workers' comp. insurance required.]
152- 81(4), and We have . oyeps
Y/ 1�(3
Type of project (Tequired)*
7. [1 N6W'd6nstr6dt10n
8. F1 R'emodelitig
9. El Demolition
10 E] Building addition
li.E] Eiec�rical rpp*s or additiQAS
1Z. Plumbing repairs or additions
l3,.0R.b6fre&ir§
14.M Other---
ppl,cant that r in their -workers' compensation policy information.
*Any aj 'bec, . C§bbkfflnid�tilsoflUoutthesectionblowshow g must submit a new af ff davit indicating such
th ar in all andthen hire outside contractors
ey e do g work, whether orpot thosepntit�es� have
wh, snbmii.th� aI&VIt indicating -contractors and statq
atta,
,he
,d �n additional sheet showing the name of the sub
tcontractors that check ox ees, they must provide their workers' comp. policy number.
employees. If the sub-c�n�actors have employ
sation insurancefor my empl6yeeS. &Jow is thepolicy and)oh site
f am an employer t1lat isprovidingworkers'compen
information.
Insurance Company Naine:
Policy # or Self -ins. Lic. 9;
Expiration Date,.
lob Site Address- City/state/zip-._ iratiou date).
Attach a copy of the workers' con1pe-psation policy declaration page (showing the policy number and
on punishable by a fulb up to $1,500.00
Failure to secure coverage as requued under MGL c. 152, §25A is a criminal violati
ell enalties in the form of a STOP WORK ORDER and a fmc of up to $250.00 a
and/or one-year imprisonment, as V as civil P a ns of the DIA for hasurance
day against the violator. A copy of this statement may be forwarded to the Office of Investig tiO
coverage verification.
--ido —hereby cer* under thepains andpenalfies oJperJurY that the information provided above is true and correct
---y /,-), A r—
Of to be completed by city or town OfficiaL
flcial use only. Do not Write in t1lis area,
City or Town:
Permit/License
issuing Authority (circle one): i
1. Board of Ifealth ?__ Building Department 3. City/Town Clerk 4. Electrical Inspector 5. plumbing Inspector
6. Other
Phone#:
Contact Person:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their enlpkdy�es.
Pursuant to this statute, an employee is defined as "...every person in the service of another -under any contract of We,
express or implied, oral or writteu."
An employer is'deffi6d as "an itidividual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enf6rprise, and including the legal representatives of a deceased employer, or the
receiv& , dr, trustdd 6 f an individual, partnership, association or other legal entity, employing empldyeO. - 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 opdrate a business or to construct buildings in the commonwealth for any
applicalit who hasnot produced -acceptable evidence of compliance with the insurance coverage ieq'uijred."
Additionally, MGL chapjqr 152, §25C(l) states "Neither the commonwealth nor any of its political subdivisions shall
enter intp any contract for the performance ofpublic -work until accep'table evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Pleasb fill out the, workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
nece�sary, supply sub'contractor(s) name(s), address(es) and phone number(s) along with their certificate('s) of
insurance. Limited -Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. IfanLLCorLLPd6eshave
employees, a policy is required. 1�e advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confmnationof 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 requ�sted, not the Department of
Industrial-Accidenis. �hould you have any' questions regarding the law or if you are rcq*ed to obtain aw'6rkers'
compensatioii policy, please call the Department at the number listed below. Self-insured companies sl�ould 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 ofInvestigations 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
thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "fob Site Address" the applicant should write F'aU 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 firture permits or licenses. A now 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.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Iudustrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-AIASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Date ................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ..........
has permission for gas installation ....................
in the buildings of .............................
at ... ........... North Andover, Mass
Fee.,� 0. Lic. No..
GAS INSPECTOW"
Check #
41.SS4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFIT-TING
(Print or Type)
/VAQ'�-Iass. Date
ermit 9
Building Location,�::?, 7k
'0
wner's Name
?
T e of Occupancy
New 0 Renovation C.
Repla ern nt Plans Submitted: Yes 0 No 0
IX
FIXTURES
GI
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes No C
If you have checked yes, please indicate. the type coverage by checking the appropriate box.
A liability insurance policy i- Other type of indemnity I-. Bond G '
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 walves this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner 'I-- Agent E
I hereby cen4y (hat all oi I he details and iniormation I have submitted for entered) in the above application are true and accurate to the best oi mv knowledge and that all plumbing work
and installations Performed u I nder the permit issued for this application will be in compliance with all Pertinent Provisions ot the Massachusens SiateCas Code and Chapter 142 oi the General Laws.
Ely Lype (it License:
.- Plumber
Title Z Gasfilter
,r7�4.1 ster nat te or Licene1jdPSnber or C
;4;� C�s Fi
City/To-n neyman I ;
he
APPROVED (OFFICE USE ONLY) License Number
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BA7SEMENT
Ist FLOOR
2nd FLOOR
3rd FLOOR
4th FLOOR
5th FLOOR
Gth FLOOR
7th FLOOR
8th FLOOR
CLINIATE DESIGN MATING
Installing 5SouthSunm'
er Street
and AIR CONDITIONING, LLC
Check
Address Bradford, MA 0 1835
one: Certificate
978-372-900'""(Phone)
1-:4torporation A24�1�c
978-372-0882 (fax)
Partnership
-Busi-ness Telephone Lic `---ber . Thhju
Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142
Yes No C
If you have checked yes, please indicate. the type coverage by checking the appropriate box.
A liability insurance policy i- Other type of indemnity I-. Bond G '
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 walves this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner 'I-- Agent E
I hereby cen4y (hat all oi I he details and iniormation I have submitted for entered) in the above application are true and accurate to the best oi mv knowledge and that all plumbing work
and installations Performed u I nder the permit issued for this application will be in compliance with all Pertinent Provisions ot the Massachusens SiateCas Code and Chapter 142 oi the General Laws.
Ely Lype (it License:
.- Plumber
Title Z Gasfilter
,r7�4.1 ster nat te or Licene1jdPSnber or C
;4;� C�s Fi
City/To-n neyman I ;
he
APPROVED (OFFICE USE ONLY) License Number
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Date. x?. ......
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..............
has permission to perform ... ..........................
plumbing in the buildings of ....................
at ..... !A .� J�'
....... ......... North Andover, Mass
Fee. Lic. No .. . .... .... ..... .......
PLUMBING INSPECTOR
Check #
A
MASSACHUSETTS UNIFOR A PLICATION FOR PERMIT TO D-0 PLUMBING
(PMt (x Type)
Masm Date— 9/,)O/,o 51 pe�� r.
Building Loc3tjon-6�R���t- Cwner's Name
Type of Occupancy
New 0 Renovation Replaceawd 06 Pwu Submitted: Yes D No 0
FIXTURES
Installing Company Name— 978-372-9999 5,eck One:. Certificate
Addreu— Climate Design Heatingand'A/t 130Corpora�uon
5 South Summer Street 0 Partnership
Business Tcqephone Bradford, MA 01835 0 hmilco.
Name of ucen-sed Plumber M-Ini Vx 'A 4L il 2 -Q a FI
INS ' URANCE COVERAGE:
I have a current iiabuity insurance Policy Or its substantial equivalent which meets the requirements of MGL Ch- 14Z
Yes 0 No 0
It You have checked y
U, please indicate the type coverage by chec*jng the appropriate box
A Hablifty Insurance "Icy 0 Other type of Indemnity 0 - Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does Dot have the Insurance coverage required . by
Chapter 142 of the Mass. GenerW Laws. and that my signature on this permit application waives this requirement
Check one:
Sig—ule of Owner 0( LMT�er-3 Anent Owner 0 Agent C)
I hweby cerW that all of the details and infomiation I haye ujbff�dW (ot entared) in abo" aPplication are tim and aocurate to the best of mY
knoMedge and that all plumbing work " katahtions Peripr1ted wxW Dernxt to( this application Will be in comp4iance with all
pertinent pr(hisjons Of the Massachusetts State PlurnN "/,aptw'l rwal Laws_
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SUR-13SIVIT.
BASEMENT
IST FLOOR
2NO FLOOR
3R
FIDFLOOR
4TH FLOOR
5 STI
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STH FLOOR
?TH FLOOR
00
STH FLOOR]]
Installing Company Name— 978-372-9999 5,eck One:. Certificate
Addreu— Climate Design Heatingand'A/t 130Corpora�uon
5 South Summer Street 0 Partnership
Business Tcqephone Bradford, MA 01835 0 hmilco.
Name of ucen-sed Plumber M-Ini Vx 'A 4L il 2 -Q a FI
INS ' URANCE COVERAGE:
I have a current iiabuity insurance Policy Or its substantial equivalent which meets the requirements of MGL Ch- 14Z
Yes 0 No 0
It You have checked y
U, please indicate the type coverage by chec*jng the appropriate box
A Hablifty Insurance "Icy 0 Other type of Indemnity 0 - Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does Dot have the Insurance coverage required . by
Chapter 142 of the Mass. GenerW Laws. and that my signature on this permit application waives this requirement
Check one:
Sig—ule of Owner 0( LMT�er-3 Anent Owner 0 Agent C)
I hweby cerW that all of the details and infomiation I haye ujbff�dW (ot entared) in abo" aPplication are tim and aocurate to the best of mY
knoMedge and that all plumbing work " katahtions Peripr1ted wxW Dernxt to( this application Will be in comp4iance with all
pertinent pr(hisjons Of the Massachusetts State PlurnN "/,aptw'l rwal Laws_
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