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Home My WebLink AboutMiscellaneous - 3 STACY DRIVE 4/30/2018cn > o < 0 m 1/4/2017 N fz ORT., VER Massachu�vl Request Town of North Andover Mail - Request cassandraolsonl945@yahoo.com <cassandraolson1945@yahoo.com> Reply -To: cassandraolsonl945@yahoo.com To: "mdeems@northandoverma.gov" <mdeems@northandoverma.gov> Maura Deems <m deem s@north andoverm a. gov> Wed, Jan 4, 2017 at 2: 11 P M I emailed this email.. I wanted to get a copy of building permits for 3 stacy drive I am looking at buying this unit and wanted to see the records. Could you please email me them Thanks C. olson httDs:Hmail.Qoocile.com/mail/calul0/?ui=2&ik=aeO2b3b5c4&view=r)t&search=inbox&msq=1596ae7elf7f6273&siml=1596ae7elf7f6273 1/1 Date../ -./2.-..."./'2 ...... ..... ....... . .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... has permission to perform .... 1..,-4 . ............... 0� ............................................. wiring in the building of ..... ............ ................................................................ at ......... — ................................ . ... North Andover, Mass. Fe6. .............. Lic.( . .............. ......... !IxM . Check # 653" 0100 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked 0- L JQ=— Lev. 1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEA SE PRW 17V INK OR TYPE ALL 1NFO&VL4 TION) Date: 3 (77 City or Town of- NORTH ANDOVER To the lns4pecto�off Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_ Owner or Tenant Owner's Address 3 �q "I e-- A A10 Telephone No. Is this permit in conjunction with a building permit? Yes -F!S] No (Check Appropriate Box) Purpose of Building Rr,-,g Utility Authorization No. Existing Service Amps Volts OverheadEl Undgrd [] No. of Meters New Service Amps Volts OverheadO Undgrd [I No. of Meters Number of Feeders and Ampacity--A DQ 0 A/C --J:2 IS C T - Location and Nature of Proposed Electrical Work: '05 -t.- y aesirea, or as required by the Inspector of Wires. Estimated Value of Electrical Work: D& - �W�en required by municipal policy.) Work to Start: A 5 A V Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERA!GE: 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 X BONDE] OTHER [] (Specify:) I ce?Wft, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: _j LIC. NO.: Licensee: 71� Y e LIC.NO.: A Aj /�-- Sig at (1fapplicable, -enter "exempt " in the licerge number line.) Address:j,ql Bus. Tel. No.:-9��j jF0,7 71 Alt. Tel. No.: - *Per M.G.L c. 147, s'57-61, security work -requires Department of Public Safety "S" License: Lic. N o. 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 0 owner's agent. Owner/Agent Signature Telephone No. PEIM-IT FEE. - 0 � - 1cf-,IA A-7 cp . �z - 9 - e � - Aw 2 tjk* 59 Ir Tke Commonwealth of Afassachusetts Department of Industrkil Accidents Office of Investigations 600 41askington Street Boston, MA 02111 www.nws&gov1dia Workers' Compensation Imillrance Affidavit: Builders/Contractors/Electricians/Plambers A�Plicant.,Information Please Print Leeibly N arne (Business/Organization/individual):_ 'T c" 0 - Yzr Address: I Q I T�P^ -t, f) 't, p-, n City/State/Zip Phone Are you an employer? Check the appropriate box: I - I am 2 employer with -pazt-time),* 4. M I arn a general contractor and I employees (Ml and/or 2. 1 am asole proprietor or have hired the sub -contractors listed partner. on the attached sheet ship and have no employees These sub -contractors have working for me.in' any capacity. workers' comp. insurance. [NO wOrkem'comp. insurance 5. El We are a corporation and its required-] 3. 0 1 am a homeowner doing all work officers have exercised their right of exemption per MOL myself, [No-workirs, comp. c. 1.52, § 1(4), and we have no insurance required.] f employees. [No workers' comp. t7isurance required-] Type Of Project (required): 6. New construction 7. Remodeling S. Demol itioti 9. EDBuilding addition 10. 0 Electrical repairs or additions I 1 -0 Plumbing repairs or additions 12.7 Roof repairs 13.[].Other t. —1 -1-5 UUX It L inust also nit out the section below showing their workeml 6ompenswion Policy infionnation. Homeown* ) submit this affidavit indicating they am doing all work and then him outside contractors �Conftcton; that check this box must submit a new affidavit indicating such. Must attached an additiorval sheet showi— the RRIM Ofthe sUb-COntrIctam. and their workers'comp. policy info 60 mia n am an employer MW is Providing: workers I compensation informatiolL insurancefOr"M employem Below is thepolicy andjob site Insurance Company Name: 9 A) '9,A-.4 Policy 4 or Self -ins. Lic. Expiration Date: Job Site Address City/StateMp.--& 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 apinst 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 unde� the pains andpenaWescfperizuy that the infOrmation provi&d above is true and correct Sima ure: Phone 9: 11 09'c"Wmeofily- DO nOt write in this areato be completed by c4 or town efficid City or Town: Permit/License 4 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 *: Information a iad 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 enW16yer is defined as "an individual", partnership, assodiation, corporation or other legal entity, or any two or more of the'foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. 'However the owneir ' -of a dwelling house having not more than three apaztments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair wdrk on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MOL chapter 152, §25C(6) also states *W "every state or local licensing agency shall withhold the issuance or reneW21 Of R 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 compliaince with the insurance requircmcnts of this chapter have been presented to the contractirig authority." Applicants Plewe fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone 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' carnpensation insurance. If an LLC or LLP does have employees, a policy is r*ired. 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 pen'nit or license is being requested, nofthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' corn ensation policy, please call the Department at the -u;—..bcr. listed below. Self-insured companies should enter Itheir p self-insurance- license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete a:nd 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 Inveqigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which Nvill be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given yW, 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 starriped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required t . o complete this affidavit ne Office of Investigptions would like to Owk you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone ana fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiggations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 6xt 406 or I- M.-MASSAFE Revised 5-26-05 Fax 4 617-727-7744 www.mass.gov/dia