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HomeMy WebLinkAboutMiscellaneous - 306 HILLSIDE ROAD 4/30/2018 (2) / 306 HILLSIDE ROAD 210/025.0-0018-0000.0 . I I p�uirpPPacnuserrssiecpmcar oneAppnaments527C1V11R12.00 Rule 8: In accordance-with the provisions of M.G.L.c.143,§,3L,the a ermit a lmcation farm to movide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed' on the rescribed form.After a emmit a lication has been accepted by an Inspector of Wires appointed pursuant to M G.L c. 166,§32,an lectrical 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 IvI.G.s c.143,§3L. Permits shall be limited as to the time of ongoingEonstiuction.activity,and maybe deemed bytheJusp.ector of_Wares abandoned_and-in.alid.ifbe—. or she has determirmed that the authorized worl�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 23 8 of the Acts of2012.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 certainpermits•and licenses concerning the use or development of real property.With limited exceptions,the Act automatically dxtends,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. /Rule 8—Permit/Date Closed: `� / / **Note:Reapply for new per It ❑Permit Extension Act—PermiMbate losed: � � 'j-�� - Ao . Date.................................. NORTH o TOWN OF NORTH ANDOVER PERMIT FOR WIRING �ss�cwusf� This certifies that ................ .....Z..Z'e�- . .. .......... has permission to perform ... !`g Ulf z. (44'0&0.(.C- - wiring ............. wiring in the building of................ O U l� ...........................:...:... �....... at..........3 C..�./.l.fir=... ....................... .... ........ ,North Andover,Mass. Fee.....sr�". Lic.No... . f .,. t ; �� ....... ....................... ... - ELECTRI AL INSPECTOR Cb..eck # A g LduttifflullWwaldlf Uf lygG '=pcy Go1&J.5,cm&z) -' u Permit No. Department of Fire Service - 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.ININK OR TYPE ALL INFORMATION) Date: l lz L0 City or Town oh 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. Location(Street&Number) Owner or Tenant / Y^ Telephone No. Owner's Address wi Is this permit in conj tion with a building permit? Yes ❑ No �K (Check Appropriate Box) Purpose of Building �S'j�P y,lC Utility Authorization No. Existing Service Amps -/j� /Volts Overhead Undgrd ❑ No.of Meters New Service JC-0Amps / 4/U Volts Overhead�' Undgrd ❑ No.of Meters ' Number of Feeders and Ampacity t Location and Nature of Proposed Electrical Work:' V I%G t`ilfQ e44Gt u Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans . Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency ig ing No.of Luminaires Swimming Pool rnd. El In- � Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMSNo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers HeaTotals Number Tons KW No.of Self-Contained -j--**-** *'"" Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 171Municipal Other Connection No.of Dryers Heating Appliances KW Security Systems y No.of Devices or E uivalent ` No. of Water Nof No.of Data Wiring: o. Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g No.of Devices or E uivalent OTHER: -Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o ec ical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE OVE 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,un e Pains and pens of erjur hat the information on this application is true and contptete. FIRM ^ /Cf LIC.NO.: 7 Licensee: Signature LIC.NO.: / (If applicable,ente nzp1�t� in the licen a number li . Bus.Tel.No.: Address: N �oblic Alt.Tel.No.. � *Per M.G. c. 147,s.57-61, ecurity work requires Depa ty"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. The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA. 02111 �,„ s.• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual)�©yQ C1 S' Address: /(� �� C�p ✓�e.,,. P�Jc�P City/State/Zip: C G( Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 1 — 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance S. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. ir Insurance Company Name: r 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 a he violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of IA for in ance coverage verification. I do hereby cer i,�under the ains p Ities o t the information provideda ovee is true and correct. Signature: Date: tO11o , Phone#: G 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 0 TOWN OF NORTH ANDOVER '0 PERMIT FOR WIRING S CHUS Et This certifies that ......... ................. /.P— has permission to perform ... ........4-a--e4i'lA .... wiring in the building of 7..... ............................. ... ........ . ........ .'T. at..3X-/...5......... ..................... .North Andover,Mass. PV �;-7169,!�� --. 0 , .( ".. Fee. ... Lic.No ........... .......... . . .... .. ELECTRICAL INsPE R­ Check # 7332 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 3 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: It/ / � 7 City or Town of. NORTH ANDOVER To theInspT of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) () 1414,1- s %U-e- G Owner or Tenant p����� J 8 G Uy12 sa t-LIT- Telephone No. Owner's Address m1?1 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Wo�/— �t� Completion of thefollowing table may be waived by the Inspector of Wires. i, No.of . Total No.of Recessed Luminaires No.o Ceil.-Susp.(Paddle) Fans Transformers KVA s No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o.o mergency Lighting rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total No. of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No. of Self- ontamed Totals I I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.o Water No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: A No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. ' Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains apil penalties of perjury,that the information on this application is true and complete. FIRM NAME: l C �c lyeop-G)n LIC. NO.: Licensee: 27Z, 20 E Signature ILIC. NO.: (Ifapplicable, enter "exempt"in the e se number line.) Bus.Tel. No?-7� �1`DS Address: � Ms ) , X� Alt.Tel. No. rt : *Per M.G.L c. 147, s. 57-61,security work requires Depament of Public Safety "S" License: 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 si 2ture below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. C� Owner/Agent Signature L Telephone No. PERMIT FEE. $ ^ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston, MA 02111 sx www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions right of exemption per MGL I L Plumbing repairs or additions 3.❑ I am a homeowner doing all work g p p ❑ g P myself. No workers comp. c. 152 '1 4 and we have no Y [ P � � O� 12.❑ Roof repairs insurance required.] t employees. [No workers' q ] 13.❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t 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. Lie.#: 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. Sip-nature: Date: Phone#: 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i UG 25 '95 10 41AM COPANI./ CORSARO P.2 VroAl6 WALL. p04 WILLOW A—LrA-4,19os.lF, g 1 rl J .A r Ste A � a � 15 , , bo t'. � w a'. • � �7TORi Doti � /� �j� GI1NE D ll!►I� ' a s ` MOTE, 1FiEi•E 15 6RA4T1'D iiEREwrrm ALL OF ltMGRA%gTczS R16t1�, TITLE Anti ILiTEkE.%T m skit, TCTl1C At-AgDoOty S•7REi:T FORMEL.`1 KNOWN AS WILLOW t-r?cCT, FOUR SEASONS ASSOCIATES,INC. 93 NEWSURY STREET, LAWRENCE, MA TELEPHONE 681.6091 NOTE: THIS IS NOT A SURVEY AND SHOULD OF USED FOR MOATGAOES►VRFo7E3 ONLY.DO NOT USE OFFSETS FOR EfTAILISHINO LOT LINES FOR THE ERE::• TION OF FENCES OR CONSTRUCTION►VR►OSSS.IF SUILOINP!STIOWH LSLS THAN ONE FOOT FROM THE tOVNPART LIKES.IT IS AOVIGEO TO MARS SURYET TOYS RIFT THM MEASVRTMINTS. I HEREBY CERTIFY THAT I HAVE EXAWINIP TNT PRIMISp,AND All BUILDINGS.EASSMSRTS AHD ENCROACMMEMTS ARE LOCATEP ON TME OROUNO AS •MORN.I FURTHER CIRTIFT THAT TNT INVIL01N01 CONFORMED TO TNT ZONING LAWS ANP AMINOMENTS OF No rANYoYE R_wMEN con. i TRUCTED.I FVRTH[R CERTIFY THAT THIS PROPERTY If NOTLOCAT90 IN TNT ISTASLIVHEP FLOOO HAZARD AREA, ►l ri�r_`~t 5 �`tL OFA MICKA�u b�TE&WIJE TO THE AZLI O G-i cq TR,U 5T CO MP^w/ t BOOK Zo2� AND TITLE INSURERS c ARRT h!� PAVE, 192 MORTGAGE INSPECTION PLAN #,6372 LOCATED \T+,STER�° PLAN No.: s�fyQ� 1, scALE- t = �fq'-oa°' 340 �1LLs II7E ��h.�'T, �o. ��1T�OVE'r�'�M� ►+.•_.___....-,*' ♦.�TT.T 1 -- TO ESC USED FOR FAORTGAM: FU71=0 ES ONLY PATE: 2 Iv 66 Date!`�o • N2 4 630 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SACMus� This certifies that . . . (�� '!J JX$. • • . . . . . . • • • • • has permission to perform . . . . / u. • . . . . . . . plumbing in the buildings of . .�/�� . . �• • • • • • . . . . . . • • • • • at .30?(. . H/'1h44• • 1/-t . • • • • • • •, North Andover Mass. PLUMBING_ ISPECTOA- Check # 37S-+ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ff Date Building Location p Sr C'c� Owners Name ��inn�I—=�— Permit# � �e T e of Occu an c S i New Renovation Replacement Plans Submi es No E FIXTUR s r t Cn _ a ° v a w H aa d CG d a a w w d w A w Q A c� aLn w H w Fcc d -< Q in a a a d x as SLR>EEVE RASA" SII' M HIM �D FIDCIZ -IM FLOCR 4M FUM SIH FUJQ2 6M FIDQt 7IH RfM SIH FLOCK (Print or type) Check one: Certificate Installing Company Name ] tr o !r AV-) f u� i�4 E r S. [] Corp. Address 17 e-- SJ, Partner. ✓t ofo J 2.7,/l1a Business Telephone ? y 7 S y L 3 7 ffFirm/Co- Name of.Licensed Plumber 1 Insurance Coverage: Indicate th type of insurance coverage by1checking the appropriate box: ❑ Liability insurance policy Other type of indemnity 11 Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the Above three insurance T ignature Owner Agent I hereby certify that all of the details and information I have subm' ed(or en )in above application are true and accurate to the best of my knowledge and that all plumbing work and ins llati d der Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus 1 e hapter 142 of the General Laws. By: igaa ot Licensealflurner Type of Plumbing License Title 01S%5 ' City/Town icense i um er Master Ef Journeyman F-1APPROVED(OFFICE USE ONLY u