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HomeMy WebLinkAboutMiscellaneous - 281 WAVERLY ROAD 4/30/20189 6-5 Date.................................. AORTPI TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING A op This certifies that .... ........................ . .... .. ....... has permission to perform ....... 2-42:904 A25;04�7 ............................................. wiring in the building of .............. . .......................................... at ....... )11 ....... k1l ....... ........ North Andover, Mass. Fee... Lic. No.Y5�0114 ......... i�ica�..� .... ... ZI r P':�O� Check 4, _J �N Permit No. Department of Fire Services �� 32 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) 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: O q- d 7 1'0 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. 2-LOwLocation (Street & Number) oZ V e 12-1- Owner ner or Tenant C k4- y 1 egi4A1_ff F 9 co Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. 9 6 Existing Service 410 Amps 12 iq Volts Overhead �[ Undgrd ❑ No. of Meters New Service 6� Amps /)_.P"/c;2 dVolts Overhead Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 57 Completion ofthefollowing table maybe waived by the In ector 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 ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ran Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number �• � �• Tons KW ......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Sectio. uritof Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or E u valent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: loyd d - X Q (When required by municipal policy.) Work to Start: f7 -t (_ Jv 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 K BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: f0 LIC. NO.: Licensee: Signature (i(%EJ LIC. NO.: (Ifapplicable, ent r "exempt" in the h nseber line.) Bus. Tel. No. Address: / n 4 Alt. Tel. No.:Qn 7, •Sv8 -I qw) *Per M.G.L c. 147, s. 5 -61 securitfwork requires Department of Public Safety "S" License: Lie. 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 Owner/Agent PERMIT FEE. $ Signature Telephone No. 'k, f J N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 4 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Address: A/ 4VA t' 2�' /-/0 , City/State/Zip: VW e904 Phone #: 6 O 3 ' 6 � s_- 7i�9 5 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 2.M 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. I 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 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 Name: 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 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 and penalties of perjury that the information provided above is true and correct. d,3 - (� _C Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # —/-le) Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other LContact Person: Phone #: II Location ,�"<Iel No. Date (*--I - - *'N AP - 0- 1 & +4 z Check # 2,31) TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 13596 2�a� Building Inspector IN F W 0 C - - . 01)' < O O O O � U U U W C W7.a W G h O a i W O � O a O W q Z G U ❑ ❑ M Cn z F15 ❑ o w F W U i w q W z w O A (24 z k C C A.to0 - -- W 0 W WF ❑ F w ❑ � rn w w, tr,.. ❑ Tom.. u z O O ❑ O O a Zz Z w.' O �. ZW.'. Ta C W H z w O O In to F.•. w ❑ ❑ ❑ cn rO z d• F O W O U En O 1 C G W I t' ❑ Z cn ❑ Cy C z y G Izz O .�- to •� qr W Z Z O G C O IN F W 0 C < O O O O � Z 0 C < O � U U U W C W7.a W G h O a i W O � O a O W q � O ❑ z G U ❑ ❑ M Cn z F15 ❑ o w F W U i w q W z w BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL -c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a property licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a 'Q DAVID CASTRICONE ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS FREE ESTIMATES HOME IMPROVEMENT CONTRACTORS REGISTRATION NUMBER 104569 In Kingston 603-642-5990 In Haverhill 978-374-7314 In North Andover 978-688-9638 In Boxford 978-887-6147 7 Hillside Road, Boxford, MA. 01921 231 R Sutton St., No. Andover, MA. 01845 I/we, the owner (s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name..........nC.....s�OS D G�►�.. C�.... JJ`16.?...h...Y......... . ...................................... ........................................ Job Address .... r�?l.................................................City:..Yt........ State ..... ................................. J.......1-.1 J�-4 ....... .ts..at.S..�......... A/0 ........S�r..,. ........ .l..s....�. 5...�... . ........J ..��.:......... ,•.:.�..�...... :d.'....... .......0 1..�..�..G..,... . ........ 1P...� . ........ �.. 3.'.........�` ......... ). y.�......... ,;;,.. .;-WA .......r .............................................................................................. ft SPECIFICATIONS .........:�.1�.... fi..`.CJ.1........Ga.�i.. I...�A........................ ......... ..�..,............. ...�...... 7Q ..................... do ..s,........./V.C-"j.. �.�.,. _. L 1�Lir- ............. .....s ................ �.. GNC - (i ......... YPA....... s. :,s-. 6 ....... ..... ... x.. V. . .............�11.�.►�.�...... w. :.... ... a....s........ ........ ........5. 1.. ...r. ..... . {!.. 1..Ji.�....F.cti.......... .......................... ..................... ......tai..►Q...1.I................................................ / - —ARM •► rs�t�11���I!!��,If� ........................................................................................................................................................................ .......... ...... Materials and labor to cost $ ........... �.!P.V. D.Q......................... Payable ...1.,�....�.n...:�� ........... ..,,C� = .. ..cn Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accordance with his (their) above obligati completionas s requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs, attorney fees and expenses, In addition to the amount due and unpaid, that shall be Incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, If any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and thrat all of the agreements and understandings of said parties are contained herald. , 'owner or Owners are not responsible for Property Damage or liability while job is in operation. 3 IN WITN SS WHEREOF, the parties have hereunto sj ned their names this ........ ... ..... day of..V.sc.�..t t, to ... cr7.a.0 L� Accepted:":. y t.a,1. W a j`I�c l^h r Lfj 1 PJ . 9:T*— Per..- .-9� . • ....... .. .. ... ....... Representative Signed ... k.,.:G. Owner Signed...................................................................................... Owner G.Jiie Liammaoouur¢�!% a�✓�aau�ci+uar,Cra i HOME IMPROVEMENT CONTRACTOR Registration 104569 Type - PRIVATE CORPORATION Expiration 07/14/00 DAVID CASTRICONE ROOFING, SID David T. Cas,tricone illside Road - ADMINISTRATOR. Boxford MA 01921 , DA AC 28P- CERTIFICATE 4F LIABILITY INSURANCE 10T 12-1999 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INTERN$T INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE W HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 522 CHICKERING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE INSURED INSURER A: TRUST ASSURANC& DAVID CASTRICONE INSURER S: EASTERN CASUALTY ROOFING AND SIDING INC INSURER C: M 7 HILLSIDE ROAD INSURER D: y BOXSORD HA 01921-� - INSURER E: nMVFRAAFC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE 13EEN REDUCED BY PAID CLAIMS. IN$R TYPE OF INSURANCE POLICY NUMBGR POLICY EFFECTIVE POLICDATEY EXPIRAn N LIMITS GENERAL LIABILITY er^nvn 7r<_C e„e7, e� EACH OCCURRENCE i 1,000,000 AIK COMMERCIAL GENERAL LIABILITY TCP 1012811 08/06/1999 08/06/2000 FIRE DA_MAOE�Aronelin a� 50,000 CLAIMS MADE La OCCUR MED EXP An oneperson) S _ 5" 000 ❑ PERSONAL 1F ADV INJURY i 1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ _ 1,000,000 jECT FM POLICY ❑ PRO- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Es soClOent) ALL OWNED AUTOS ILY INJURY SCHEDULED AUTOS E(ZI)pennon) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accI09M) i PROPERTY DAMAGE $ (Per eccl0ern) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ (�ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE 6 07OCCUa CLAIMS MADE AGGREGATE i M1 i S DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT i 100,000 - .-_- B 99 A24009 09/23/1999 09/23/2000 E.L. DISEASE - EA EMPLOYE i 500,000 E.L. DISEASE -POLICY LIMIT 3 200,000 OTHER DESCRIPTION OF OPERATIONSAOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ROOFING AND SIDING j rumAIIVIV ivou SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OF CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN ' NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENT AUTHORIZED" E er^nvn 7r<_C e„e7, e� j rumAIIVIV ivou 0 rA W cd � w o o 0 w° N n cin Cd o u z or - C w2 a a�' U w a�' m w w W 9:4 u cn w a a �°D ro w z c r� ci, o cn L cm 0 CA C.0 m m CD �t fr O �43 o O CD L Ca m O d a. CO2 O_••• C �� .v J a Ovi C Z:CD cam � V CO) c C c •_ C. 0 LU 0 U) LLI U) ccW w W LU U) O m C O ` ' C N � ?i ' C ' ;c o cw .a c ea CO i m C ;= O Q L 3 ym.. C :tea m O o v �. cm K .SC fti E CO y m O O d 0to0 v s y cmO 3 r N zip y CA Smo a� 75 y m CDm cm S p,Ct 'O m m O � y 0 • O� Z Ila, O O �• .�. C d O Of C o m 3=: N ~ 0 (me m CIOy„ 4D mi �E m H O W C.3 Lm��=s w � � x v � SZ O cm 0 CA C.0 m m CD �t fr O �43 o O CD L Ca m O d a. CO2 O_••• C �� .v J a Ovi C Z:CD cam � V CO) c C c •_ C. 0 LU 0 U) LLI U) ccW w W LU U) Location No. �16 B Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ U5. FoundationPgrit Fee $ ' p V %tt!1 $ Fee Sewer Copption Fee $ Oter GoNnection Fee $ TOTAL 0\\edk13, rl 3�r Building Inspector Div. 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