HomeMy WebLinkAboutMiscellaneous - 30 JAY ROAD 4/30/2018 (2)_. 1 z ' .
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North Andover Board of Assessors Public Access
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j4property Record Card
Location: 30 JAY ROAD
Owner Name: GALE, WENDY L
Owner Address: 30 JAY ROAD
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 6 - 6 Land Area: 1.03 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 1872 sqft
ASSESSMENTS
a] Value:
Ming Value:
id Value:
rket Land Value:
mter Land Value:
CURRENTYEAR
361,800
154,700
207,100
207,100
PREVIOUS YEAR
361,800
154,700
207.100
http://csc-ma.us/PROPAPP/display.do?linkld=1 893798&town--NandoverPubAcc 7/16/2012
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Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 101 A60.00
rn
$ -
$
1,217.52
Plumbing Fee
$
152.19
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
152.19
Total fees collected
$
1,621.90
36 Beave brook Road
754-15 on 4/2/15
water damage repair
PAA
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Date.1.1 �9
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies tha 47
........................
has permission to perform ...... . . .....
wiring in the building of ........
..............................................................................................
at cx, pd.
................................................ ....... I North Andover, Mass.
:�- W ...................................
Fee
..... 0--(-) ...... Lic. No . ...........
Check lit) P, ELECTRICAL INSPECTOR
2 6 8
ig
Official Use Only
0� —
THE COMMONWEALTH OF MA55ACHU5ETT5 Permit No. G
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00
(Please Print in ink or type all information) Date 09/15/15
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number 30 Jay road, North Andover MA
Owner or Tenant Eric T Mclean
Owner's Address 30 Jay road, North Andover MA
Is this permit in conjunction with a building permit Yes X No (Check Appropriate Box)
ZA29 UA 72 Lj
Purpose of Building Residential Utility Authorization No.
Existing Service ;�VO Voits Overhead -
___aO Amps Ile Undgmd - No. of Meters
New Service ;QaO Amps voits Overhead - Undgmd - No. of Meters
Number of Feeders and Arnpacity
Location and Nature of Proposed Electrical Work Upgrade service to 200a and install 5.75KW Solar Array
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES X NO
have submitted valid proof of same to the Office YES X NO If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE X BOND = OTHER (Please Sped
Estimated Value of Ejectrical Work$ (Expiration Date)
e-7 I , (9 0
Work to Start MR 3 Inspection Date Resquested Rough Final
Signed under thi Penalties of perjury:
FIRM NAME Pro Star Electric, Inc. LIC.NO. MR1085
z 4fir
Thadeus A Gadomski III —Signature 4 �::;��_�LIC.NO. 35478E
Bus. Tel No. 617-816-6884
Address 11 Malvern rd. Norwood MA 02062 —AftTel.No. 207-951-06,38
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance covera§e or Its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
—Telephone No. PERMIT FEE $ j2vJ--
(Signature of Owner or Agent)
12A
Total
No. of Lighting Outlets
No. of Hot fuse
No. of Transformers KVA
Above
In
No. of Lighting Fixtures
Swimminq Pool gmd
gmd
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
* Municipal . Other
No. of Dryers
Heating Devices
KW
Local Connection
No. of
No. of
Low Voltage
No. of Water Heaters KW
Siqns
Bailases;
Win'nq
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES X NO
have submitted valid proof of same to the Office YES X NO If you have checked YES please indicate the type of coverage by checking the appropriate box.
INSURANCE X BOND = OTHER (Please Sped
Estimated Value of Ejectrical Work$ (Expiration Date)
e-7 I , (9 0
Work to Start MR 3 Inspection Date Resquested Rough Final
Signed under thi Penalties of perjury:
FIRM NAME Pro Star Electric, Inc. LIC.NO. MR1085
z 4fir
Thadeus A Gadomski III —Signature 4 �::;��_�LIC.NO. 35478E
Bus. Tel No. 617-816-6884
Address 11 Malvern rd. Norwood MA 02062 —AftTel.No. 207-951-06,38
OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance covera§e or Its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
—Telephone No. PERMIT FEE $ j2vJ--
(Signature of Owner or Agent)
12A
,"MITI
.The Commonwealth of Massachusetts
Department of IndustrialAceldents
1 Congress Street, Suite 100
Boston, YM 02114-2017
wwwmass.gov1dia
Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH TIIE PERAUTTING AUTHORITY.
Name (Business/Organization/Individual):
Address: llln-411o�_4 XE--tY
City/State/Zip:
Are you an employer? Check the appropriate box:
aoco-�-_ P -hone #: 0?0 -;;;,— 0? --g /_
I 0I I am ' a employer with ;;?O_empIoyees (full and/or part-time).*
2.E] I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. n I am a homeowner doing all work myself. [No workers' comp. insurance required.] f
<1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensu ' re that all contractors either have workers' compensation, insurance or are sole
prolrietors with no employees.
5.FJ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors fia�e' en ployees and have workers' comp. insurance.1
6Q We are a corporation and its officers have exercised their right of 'exemption per MGL c.
152, § 1(4), and we have nok �pployees. [No workers' comp. insurance required.]
Type of project (Tequired):
7. FJ New construction
8. F1 Remodeling
9. Demolition
10 E] Building addition
11. Elect rical repairs or additions
12. E] Plumbing repairs or additions
13. E] Roof repairs
14. F1 Other
*Any applicant that checks box 41 must also fill out the section below, showing their workers' compensation policy information.
I Homeowners who submit Us affidavit indicating they are 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-co'ntractors have employees, 1hey must provide their workers' comp. policy number.
I am an employer th at is piovidbig workers' compensation insuran cefor my employees.' Below is th e poliey an djob site
information.
Insurance Company Name:
Policy # or Self -ins. Lie. q0 50 S 0 'r. Expiration Date: (,p
Job Site Address: (A a �v City/State/Zip:
Attach a c,opy of th�"workersl Ampepsation policy declaration page (showing the
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do h ereby certify under thepains andpenalties ofperjury that th e information provided abpvc is true and correct.
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one): 'I
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their e ployees.
in :
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract �f �ire,
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 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
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 be 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 of this chapter have been presented to the contracting authority."
pplicants
Please fill- out the workers' compensation affidavit c�ompletely, 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 (LLQ 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 Depattment of Industrial
Accidents fbi confirmation of insurance coverage. Also be sure to sign and date the airidavit. The affidavit should
be returned to the citypr 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 re'quired to obtain a workers'
compensation'policy, please call the Department at the number listed below. Self-iiisur6d 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 permit/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 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 Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Date .... Z. —.. Z/
TOWN OF NORTH ANDOVER
PERMIt"FOA WIRINd
This certifies that ...... ....... ........ :2 ................... ...............
.r2
has permission to perform ..... .. ......... ................
wiring in the building of ....... 1,/—. 0 .... .... ................. ................................
at ....... 3.,(l ...... ,r. ............
....... ........ North Ando Mas
Fee 3: j ............ IAZNcIZL".--3�� .......... ;,0 . ... .......... ........ ....
A iINSP R
Check #
10441
4
4L Commonwealth of fifassachusetts
Tuse only
Pepartment of Fire Se�Vkes P=16i, No. . 'ja
BOARD OF FIRE P*REVENTION REGULATIONS OccuPancy and Fee Checked
ec
V
eave
-A bb E::
I lt%Aor
1%J14 rUK rt:KMIT To PERFORM ELECTRIC
All work to be perfc�med in jccojdw�e wit� ALWORK
the Mas=hvS4U ElectriW Code (MEq, 527 CMR 12-00
(P-LEASEPRWflVNK01Z TYPE'UZE&0MMT10A9 Date:
UY or Toivn of.- NORM ANDOVIER -To theInspec
By this application the undersigned gives —u— 01 hn or her.intaution -to ' tor of Wires:
Pc#�tm the electrical work described below.
Location (Street & Nuiaber)
Owner or Tenant
Ownerts Address Telephone No.
is this permit in MAJunction with a building peinW
-j t" No
4 ek Appropriate Box)
(Che
PUTPOSe of Building Uffilly Authorlmatlon No,
1�7
c
is
Exis&g Service
Mew Service er. ead .0-----U1L4PdE1 No. of Meters
Jiimpg 7 Overhead 0. Ujmdgrd [3 No. of Meters
Number of Feeders and"Am - - -- '- - '—"— - —' - - ' - - , I
pacity
Location wid NaiOe of Proposed Fiectrical Work-.
CO lefibh a Ap-
No. of *cessed Lwrhal�es No. of CeEL-S (Paddie) Fa=
USP -
No. of`Lumiw&e 0,jtj,�.f.-
Ab Ye
swbim14 Pool 01 0
2rnd-
No. of Receptacle 011111
ets
No. of Switches No. of Gas Burnen
V-
-- J, �1=1!7. . ;—'- " - z!
- 01 Juinges --Te-t-ar�
No. of Wnte Disposm NO. -of Air Con& 'T
Ulm:
NO- Of Dishwashers ace/Area Ireating
SP XW
No. of, Dryen ReatI4:kjoim�mces KW,
I.No. of Heaters' K"W o.. IN 0. 01
s
NO- HYdromassage Bathtubs N
o of M4�toii
Totai HP
OTHzX-
ALARMS JNo., Of Zoneg
Aftg )evicei
k. of Se -U.'
teeU6 ertin Devi
C,d[]
Oeer
-VX
whtig.-
x of Devie 6r.kn�wj..+
es U
ii:lsli;�e'g or W
EstimaLed Vaiue it 1!�1;11!���!�l�11!111���''l�'!!''i',II
Of Eleciric'al Wbrk- by the Jympeaor 9f Wira.
W6rk to� Mari (Whell repired by municipal po&y4
1�817ectiolls tO be requesW in accordance with AMC Rule
INSURANCIf COV—E-U--GE.-, -U�ess waived by the '10, and Wn coMledolL
the fleens owner, no
eeirovides proof of liabft insurance including ., Per= for the perfbInlance of electrical work My issue unIess
Wmplew ol�ii:e --
undersigned certifies that such coverage is - c. r-OvenW or it, sub9tanfiW mpAvalent The
and has exhibited proof of saTe to the p6inft issuing offir
CBBCk ONE rN§UR-A'NCE'. e.
0 011IM'0--�Speciiy-)
I cer*, under thOp4fiis �ndpendda ofpej�k% tia t)L
jaf
FnM NAMZ: onnalon 0-n this 4V4*��4� hr &ue and compkm
Licensee: lic. No edgl"Fof
(If applikeab Slznatu�e
en arempt in numberbw) LTC. NO.
Address: BUL Tel. No. -
*Per M.G.L c4 147, s, 57 -6'1 -
Security Work requires Depaftn=t Public Safety 'IS" Lice=: Alt Tel. N..:
Lic. NO.
O*N9R'iJNSURANCE WArVFX- I am aware that the Li,� does notfiave the liabnIty Wj6iijic� coverage nornm y
required by law. By my signature below, I hereby Aive this req*,ment I ovv=t
Owner/Agent am the (check owner El s
Signaturi � Telephone No. 9zi
ELECTRICAL PERMIT NO.- INSPECTION, REPORT:
ELECTRICAL INSPECTOR - DOUG SMALL
1. ROUGH INSPECTION:
Passed 7 Failed — I Re -inspection required (S50.00) -
Inspectors' comments:
(Inspectors' Signature - no initiab) Date
4
2. FINAL INSPECTION:
Passed — Fafled — Re -inspection required ($50.00) -
Inspectors' comments:
U4
(Inspectors' Signature*- o W
11 i 4*1s) . Date'
3. UNDIER GROUND INSPECTION:
Passed—[ f ' Fafled — Re -inspection required ($50.00)
Inspectors' comments:
(Inspectors' Signature no initials) Date
4. INSPECTION — SERVICE:
DATE CALLED NATIONAL GREW'' NAMIZ:
Passed — Failed — Re -inspection required ($50.00) - I
Inspectors' comments:
(Inspectors' §i0ature - no initials) Date
5. INSPECTION - OTHER:
Passed — Failed — Re -inspection required ($50.00) -
Inspectors' comments: JL
(—Inspectors' Signature - no Initials) Date,
DOOR TAGS ARE TO BE FILLED ouT AND. LEFT ON sra u� TE[E AREA To BE INSPECTED IS NOT
ACCESSIBLE AND A RE -INSPECTION OF'$50.00 IS TO BE CHARGED