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HomeMy WebLinkAboutMiscellaneous - 29 COLUMBIA ROAD 4/30/2018 (2)J11 accOrdance-WithtlIeTIOVisiOns; OfM.CT.L. c. 143, §.3L, the permit application form to provide notice of installation of wiring shall be uniform throughoutthe Commonwealth, and applications shall be filed - on the.prescribed form. After a permit application has been accepted by an Inspector of Wires app'ointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firpi or corporation stated on the permit application. Such entity shall be responsible for the notification * of completion ofthe work as required in KaL. c. 143, § 3L. Permits shall -be limited as to the time ofongoing construction activity, and may bedeemed-by-theJjaspector-of-Wires abandoned.auddmvalid-ifhe�_. or she. has determined tlia't the aufhorized 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. n The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections.74 and 75 of Chapter 23 8 of the Acts of 2012. The purpose of this act is to promot6jobigrowth and long-term economic recovery and the Permit Extension Act finthers this purpose by establishing an automatic four-year extension to certain -permits -and licenses conceming the,use or development of real property. With limited exceptions, the Act automatically dxtends, for four years beyond its other* VVIS e applicable expiration date, any permit or approval that was "in effect or existen&'during the quialifying period beginning on August 15,2008.and extending1hrough August 15,2012. Aiile 8—Permit/Date Closed: Note: Reapply fornew permit 0 Permit Extension Act — Permit/Date Closed: Date. T�.is certifies that. . ' has permission to perform . . ............. wiring in the building of . . . . 4-4c! . . ................... o An over, Mass. at ..... h d Fee .6�. rA7 Lic. No. 2:07,�?2—/� ........ . . ELECTRICAL INSPECTO/O CN,xk # 11272 Official Use Only MamacLmib -7 Permit No. - J) 2 2,fad.d ol-%- Sertlkw I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. 1/071 (leave blank) APPUCATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code , , 5 MR 12.00 (PLEASE PRTNT TN TNK OR 77PE ALL XFOPL4 T7ON9 Date.: \ �, 12 7(a City or Town of. N - 76M (J (D\Jf) K To the Inspector oJ- Ores: By this application the undersigned gives notice of his or her. intmtibn to perform electrical workdescribed below. Location (Street & Number) Rnaer Telephone No. Owner or Tenant Owner's Address J CD a 5� S, Is this permit in conjunction with a building permit? Yes E] No (Check Appropriate Box) Purpose of Building - - -Q- , A Utility Authorization No. Existing Service Amps Volts Overhead El Undgrd El No. of Meters New Service Amps Volts Overhead Undgrd E] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following (able may be waived by the Inspector of Wires. No. o TotAl No. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans iTransformers KVA I — KVA No. of Luminaire Outlets No. of Hot Tubs lGenerators Aboye In- mergency Lighting No. of Luminaires Swimming Pool Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of D ti n and No. of Switches No. of Gas Burners Initiating Devices otal .0 of AlertingDevices No. of Ranges No. of Air Cond. Tons of Self -Contained Reat rump lj�.uxllbvl I Luna No. of Waste Disposers Totals .......... b;iection/Alerting Devices Municipal 0 Other No. of Dishw Space/Area Heating KW Local E] Connection No. of Dryers Heating. Appliances K -W mt Wi No. of 0. of Data ifing: No. of Water KW Ballasts No. of Devices or. Equivalent Heaters Siens Telecommunicauons W. [No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uiva ent IOTHER: A tach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy) Work to Start: Ins e ions to be requested in accordance with MEC Rule 10, and upon completiom no permit for the performance of electrical work may issue -unless INSURANCE COVERAGE: Unless waived by the owner, n The the licensee, provides, proof of liability insurance including "completed operation" coverage or its substantial equivale t undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CIAECK ONE: INSURANCE 54 BONDE] OTHER 11 (Specify-) I certify, under thepains andpenalfies ofperjury, that the information on this application is trite and complete - LIC. NO.- � I)] FERMNAME:m LIC- NO - Licensee: / Signature J:!�,'7 (if applicable enter 11 exempt?, in the license n ber line) d-!c�Bus. Tel. No. Address: Higi r 0" Alt. Tel. No.-5DX-La94—Jb.-,>, I *Per M.G.L. c. 147, s. 57-61, security work requires De entofpubli<�Saf�ty'-'S?7'L�icense*- 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).El owner Elowner's agent. Owner/Agent Telephone No. . �;E"IT FEE: $ 0 Signatule Z_ (- P The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 _14� www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Business/Organization/Individual),:A/og -rh A -AST"! rlzz I ^ I AMAMA�_1 i,o: MFL� /, Are you an employer? Check the appr 1. g I am a employer with employees (full and/or. part-time).* 2.0 1 am a sole proprietor or partner- ship afid have tio eihp16yee8 working for me in any capacity. [No workers' comp. insurance required.] 3. El I am a homeowner doing all work myself [No workers' comp. insurance required.] T Phbne#: riate box: 4. [] 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. IMUYMU.: 5. F� 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' comv. insurance reouired.1 07 - ?b64- 7��7 Type of project (required): 6. E] New construction 7. Remodeling 8. Demolition 9. E] Building addition 10.9 Electrical repairs or additions I I - F1 Plumbing repairs or additions 12-E] Roof repairs 13.F] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Npineowners 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 whet . her or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: 6YA1Z,42 IlUttRAXIQ5 Qoqj� Polity # or Self -ins. Lic. NO V C 3-17366 Expiration Date: 1 - zg 9,�? Job Cite Address: aq mb ('o, U City/State/Zip:)�,t/A—h Ar&ve Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as Tequired 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 Q01 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 undefolepains an41qhaAW0fperjury that the #!Prination provided above is true and correct. MM QfjZcial use only. Do not write in this area, to be completed by city or town offlei& 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 #: ,N2 9703 0 0 0- . 2 &S CHO This certifies that /-Z/3//-2 Date ............ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ........ .................. plumbing in the buildings of . . at ...................................... North Andover, Mass. Feej.zo - Lic. No.. ...... PLUMBING INSPECT06 Check # J-/ :14/1 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer V_ MASSACHUSETTS UNIFORM -APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK A 1P CITY I.. (7)_ L:ff _v ./-Y. noosi.-t-, MA DATE PERMIT#- JOBSITE ADDRESS R q_ (�n -- FC17TH OWNER'SNAMEI,_V al hn-A.- . ...... I OWNER ADDRESS TEL FAX TYPE OR OCCUPANCYTYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: F-1 RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES[] NOO� FIXTURES -1 FLOOR- 13sm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE MOP SINK .'TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER =L F-7 =F INSURANCE COVERAGE: - I have a current jjg�insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[Z] NO E] IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE OF INDEMNITYE] BOND E] 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. CHECK ONE ONLY: OWNER [:] AGENTE] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true c te the best of my knovAedge and that all plumbing work and installations performed under the permit issued for this application VAII be in co. Wit ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I_PhilIiP_Pq*_ LICENSE# SIGNATURE MPEI JP El CORPORATION El #�PARTNERSHIPE-1# LLCE]# COMPANYNAME gL&..Heafi!Lg�LC ADDRESS CITYF_ ZIP ,pennis STATE TEL FAX 508-966-7448 CELL EMAIL I Phil@dul��plpTb�ng.com V_ -4 e -6a, E�D p us -j�,WEALI ;-vi C)rr ' ft ID A M M E S A L PLU s A UE THE ABO'JE LICENSE TO: jjRFF-E j D A ST 14A 5 1 �01 �4 0 t' Along All P.00'et'.� F.W.ThAn OMMONWEAL HOF MASS ------- 7. ACNUSEfT-j--' PLUMBERS AND GASFITTERS ICE] YSED AS A JOURNEYMAN PLUMBER ISSUES THE ABOVE LICENSE TO: P'H,I L L I.P i DURFEE ST F -I-s MA 02638-2417- ..'262-32 05/01/14 FOK Then Detach Along All Perfora§ons* �COMMONWEALTH OF MASSACHUSETTS - PLUMBERS AND GA F S. REdIST--ERED AS A PLUMBI CORP THE ABOVE LICENSE TO: PH.-ILL.IP. J DURFEE -,D11RFEE "PLUMBING & HEATING, LLC 11" 41 T -5 FLAX S A bENN-I9 MA* 0263*8" 2471.1" 05/01/14 LICENSE NO. EXPIRATION DATE SERIAL NO. 10/11/2013 12:OOPM FAX The Coyff-monweafth of Massachwats Department ofxnduYHa1Ar_eMe?z& Office 9f Investigations .600 Washington Street Boston, MA 02111 vwmass.govldia Workers` Compewadanf4snr=6 Affidavit- Wders/Coxxtractors/Ele'ctridans/)?Inmbers � ME ,Addiess I city/statezip: ro, Pho-aeA A -re o�x in employer? Check.&6 -&�propriatebox, 4. 1 am a r-oatrabtor 6d I V1 1. am a Mopl. general .'employeae (ftu and/ or Pgat-Ame) - I =' a �ole p,roplietol Or parh=- have hired. the sbb dantmctors skp and bave no omploytes Tbesp, w6-contradors havo working �oz me in =y cap,�city- emplo*s znd havc workers' LNO wozkers' wxnp ins�e' con3p. InomceJ, 5. We are "a coTporadon and ts 3. 1 am i biomaovmar -doing all Work officers have exexcised their myself. [No workers' C=P. right �5f examption pei MOL G, 152,. § 1(4.), and wo have no insurance rtquired.] t employ=, [No -workers qomp. insumnoe req=d-1 ,Type of prioject (r8qW"red);. New oonstructioll 7. '§Cwdcling -8. U Dtmolition 9. 0.8�ildm' a"fi�n , g 10-E] -Elzct�calzcPai-rG 0, add ition s I l.VPl=bffig repairs or additions 12.Ej R�of Tepain 131� other *�ny applicact ffixtch=jrSb�xjWj matidsa rjU out the sectionbc1ow showing ibeir warkcrs'coniP=Wion?o1icY infomation. t Hamcownm-s who subinit tWu affidavit indicating they am doing al1workand then hirt wtside coribmtors mwtsubitit a new affidavit indicating mch,. �Cont=tors thit check Us boxinust attached an addi�onsl sheet showing the name of the sub-c=k=s= and state whother or not those entitia bava employces. lfthcsub—mnwtDr� -nair, =�Joyrcs, they must pmvidb their workcm, carnp, pohoy number. Ian an employer that ispro�14�g, insurtuice rmyemployee& BelffwigthepoUL andjobsUe fa Y inforntafie& — - , A — Insurance Company Nz)me. 74 -1 1 I/F 0 - f 1 r I'D L,' V Policy # or self-ing. Lic. #.7L? Eypim�on D�tr_ 01 /2� Tot, Site AddreM Attach a copy of the workers' 6ompensation policy declaratioa pat:r e"(&howing the policy number and expiration date). F�djuxe. to secure coverage a -req&cx1,under Sectibn 25A of MGL c. 152 ran lead to. tbz itrposition of cj�� penalties of a fine iip to $ IF300.00 an&or ote-yoaz impriso=eut, as well ag civil pe . naltirs in the form of a STOP WORK OnER =d a fine of up to. V50,00 EL day agaiubt tho vio.., 1�tor. Be advised t.haf a copy, of tU8. statemmit may bo.forwarded to the- oj�ri6e of I �fo hereby use City or. Town: p�naMes of .parjary that th� Inform ado ni Provided ahn ic f -A and correM Date: area, ib be .�r town offidaL Issuing Auffiority, (VArcle one); 1. BoRrd of Readth 2. Buidding Department 3. City/Tov(.n Cler.k 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person- Moe CDIuml! Gas - of Massk-husetts A NiSource Company 995 Belmont Street Brockton, MA 02301 January 23, 2013 Mr. Roger Talbott 29 Columbin Rond N`ar-th 01849 Dear Mr. Talbolit: During a recent visit, our service technician deteCted a safety problem with your gas conversion burner at 29 Columbia Rd., North Andover, MA 01849 — leak on pilot tubing to boiler on nowly installed gas valve and left hot heater off. Accordingly, we have issued 11 Warning Tag because of this situation, Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737, Acts of 1960, requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-677-5052 and ask to speak with the Ser -Oce Supervisor. Please disregard this notice if the condition has been corrected. Sir! c erdy, Custortier Service Department Columbia Gas of Massachusetts V/' Golum]Ka Gas,-, of Masskhusetts A NiSource Company 995 Belmont Street Brockton, MA 02301 December 21, 2012 Roger Talbott Account Number: 421340301 29 Columbia Road North Andover Ma 0 1845 Dear Customer: I ip During a recent visit, our service technician detected a safety problem with your gas pi ing located at 29 Columbia Road North Andover Ma 01845- Leak on pilot tubing. Accordingly, we have issued a Warning Tag because of this situation. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the 'installation of gas appliances and gas piping, established under Chapter 737, Acts of 1960, requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-677-5052 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts CRR: 8588 12/21/12 CAcisupdatedletters\1 10 Colum Gaso of MassYchusetts A NiSource Company 995 Belmont Street Brockton, MA 02301 December 13, 2012 Mr. Roger Talbot 29 Columbia Road North Andover, MA 01845 Dear Mr. Talbot: During a recent visit, our service technician detected a safety problem with your gas conversion burner 29 Columbia Rd., North Andover, MA 01845 — gas valve to hot water heater passing/turned off. Accordingly, we have issued a Warning Tag because of this situation. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737, Acts of 1960, requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-677-5052 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts Location C12 CC3 1(4 C." t0i; / No. Date TOWN OF NORTH ANDOVER .,jjM,ggW to Certificate of Occupancy $ 1 Fee $ Building/Frame Permit Foundation Permit Fee $ C14 S Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ "'—Z Aa ccxsk Building Inspector '12 Div. 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CD CD . r - Z =-o Co 2 co CL CD CA =r 03 CD CA CD -Ic 0 0 0'0 - -2- =CD CD CD -1 -4 CD C42 0 Z — c) CO) r) T.0 C =r al co Q OR at z CD to 0 CD C') co CD 0-4 C/) (0 0 CD =r co m n cD 0 0= w =IN :3 0 cm —N I 'CD CD 0 -C : CA CD cc cr CD CD CD CD 0 CD = C=D CD CO) CD ZCD C=D CO CA CD CO) Co 10 z CD CD CL CD 0 C=01 CD cl CD: z m cn 0 ro (n w ;z 0 cp CD 7i n pcj 03 cp cp CA al 0 cn M cn w Nl� X OFFICES OF: -TO-wM Main S APPEALS --,North Andover. -NORTH ANDOVER BUILDING massachLL-ietts o I 84s CONSERVATION DIVISION OF HEALTH P I ANN ING PLANNING & COMMUNITY DEVELOPNIENT KakRE_N* HP. NELSON. DIRECTOR with the rov ; --1 a cor.diiiicn 'of Number is U.1 hat ':'d dctr-"s resulting ;rcr, this -ark shall be di-sposed of ;,-i a 'orcoeri.,- scl, C, ­ - - - I - ___ __ - -, ____ __ Z -S 7ne debr4sxill be disposet! cf ;,: NOTt—': Demolition permit from the Towra of' North Andover arust be obtained for this project through the Office of the Building Inspector.