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HomeMy WebLinkAboutMiscellaneous - 31 HEWITT AVENUE 4/30/2018 31 HEWITT AVENUE �' 210/060.0-0047-0000.0 - Date............ ..7...� ......... r10RT/� TOWN OF NORTH ANDOVER # * PERMIT FOR WIRING ,88gCHU8E This certifies that .. ..�.�'... e,4 Jvt ........ .................a` .......`.......` '....................... has permission to perform ...... .................................. JYL� ,,................................ wiring in the building of....... I �N 2t ...............................t . ......................,N Andover,Mass Fee:J.�....'"r..........Lic.No.�I2OV..... ........ . .......... . .. ... ELEC CAL INSPECTOR Check# � Uj r),P -f�r III- 1� Vv-, Commonwealth of Massachusetts Official Use Only \ � 2 Department of Fire Services Permit No. 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 CodeC),52 CMR 12.00 7" (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 3 e w Owner or Tenant ri 6 he^ Telephone No. - a Owner's Address u Is this permit in conjunction with a building rmit? Yes No ❑ (Check Appropriate]Box) Purpose of Building �r�,,� rte^ 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 Locatio and Nature of Proposed Electrical Work: _ tv tL r Cw: Completion of the following table may be waived by the Inspector 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- ❑ No.of Emergency Lighting rnd. grnd. 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 and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....."" " '""'"'"'"' 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.of Water No.of N .of Data Wiring: KW Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Atiach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectr al Work: D (When required by municipal policy.) Work to Start: S 2 ar Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE 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 cover is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pe altiesf erju ,that the i ormation on tlti ation is true and complete. FIRM NAME: . LIC.NO.: S/a2o&— Licensee: a a v vq-o Signature LTC.NO.: (Ifapplicable,ent �xe :in the ce e umb line.) j�J Bus,Tel.No. yj� 907-.Z�s Address: ,� 4 d bl Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of lic Safety"S"License: Lic.No. P-'zIO& 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 agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. i 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, §32,an • electrical 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 M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized 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. i 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 238 of the Acts of 2012.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 certainermits and licenses limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration ation datte e use orvany permit or approval that of real prope . 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 permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Ins ection Pass M Inspectors Comments: Failed 0 Re-Inspection Required($.)❑ Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed M Inspectors Comments: Re-Inspection Required($.)❑ Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Q Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 t Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors ignature: Date: 'MAL INSPECT ON: Pass� Failed Re-Inspection Required($.)❑ nspectors Comments: I ElnspectoErsSignature:7 Date: :B WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofMassachusetts , - Department of lndustrigl Accidents Office oflnvestigadons 6#0 Washington,S'treet Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Suifcle>r°s/Contractors/Electriclans/PZiimbex s A lilease Print Le b Name(Businessiorgani'zation&da'.vidual): r G p,�C_ �, , Address: - City/State/Zip: 1�G✓cPARI d�: Phone 2& - 8d 7 X04 J'— Are you ars employer?Check the appropriate box: Type of project:(required): 1.[1 I am a employer with 4. ❑I am a general contractor and I ' 6. ❑New construction ployees(full.and/or part titna).* have liiredthe sub-contractors 2. I am a sola proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and`have no-employees These sub-confractors have 8. ❑Demolition working fox me in any capacity. workers'comp.insurance. g, [,Building addition [No workers' comp.insurance 5. ❑ We area corporation and its re officers have exercised.their 10.[]Electrical repairs or additions quired.] 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.Q Roofrepairs ' insurancerequired.)► employees.[No workers' 13.❑Other comp.insurance required.] XAny applicant that checks box#f must also fill out the section below showing their workers'compensation policyinformation. "'Homeowners who submit this affidavit indicatingthey adoing all work and then no 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.UG.#: Expiration Date: Job Site Address: /State Ci : r t5' /Zi p Attach a copy of the workers'compensationPolicy declaration page(showing the policy number and expiration date). Pailusre to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or ones-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the 'oXator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for" co coverage verification. X do iereby certo uri r al7Zs and penaltles of perjury that the information provided a ove i true and correct. - Si ature• /� Date• 7d Phone#: l 7k- F07- aG ,:5— official use only. .Do not write in this area,to be completed by city or town official. City or Town: Permlaicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cily/Tow.n.Clerk. 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 11 Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees, pursuant to flus statute,an employee is defined as"...every person in the service of another under any contract o�hire, express or implied,oral or written." An employei is defined as"an individual,partnership association corporation or other legal entity,or any two ox more of the Foregoing engaged in a joint enterprise,and including the legal representatives of a•deceased employer,or time 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 p ,§ (6)also states that"every state or local licensing agency shall withhold the issua renewal of a license or permit to operate a business or to cons' ruct buildinnee or tgs 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 Y an contract the . performance ofpublic work until requirements of this chapter have beenpresen ed to the contracting acceptable th r evidence of compliance with the insurance Applicants ' I Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their ceA icate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP with no em to ees other than the members or partners,are o , p Y h p , not carry workers compensation insurance. If an LLC orLLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of fudustrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be,retumed to the city or 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 required to obtain a workers' compensation policy,please call the Department at the number listed below: Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be,sure that the affidavit is complete andprinted 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 pemnit/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 ci or town)."A:co of the affidavit the . pY davit that has been officially ffi tally stamped oxmarked by the city or town may be provided to the applicant as proof that a valid affidavit-ii on file For future permits or licenses. Anew affidavit must be Riled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture , (i.e.a dog license or permit to burn leaves eta.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 and fax number: Tho emmouWaam,of M1.0 ssa..c hv.:sotts Deparb.eut Q.flaftftial Accxdauts Of Me QfTAVQStfga•�tQ7n� 600 Wakij gtau Street So9Q 021 X � . x Tei, 617-72,.7-4900 at 406 or 1-87`�.:11ASSAFE Revised 5 26-05 `ay,0 617-727-7749 COMMH�NEALTH OF MASSACHUSETTS ® I Et_E.CTR ICI ANSmom ISSUES THE FOLLOWING LICENSE i AS A 'REGJOURNEYMAm Awl N >ELE TRI C I AN Z , MIC1iA.EL 6 RAYMOND ,., W 24 TRUms MBULL AVE fJ f HA.V:ERP11 LL. M'A 01832-373 + { 32 75 ;. 5t208 ;� 07/3 /]6 . , - ZONING INFORMATION: ZONING DISTRICT : R3 ASSESSOR INFORMATION: MAP 60C LOT 47 DEED REFERENCE: BOOK: 12965 PAGE: 282 N61'51'15"E N64'43 06"E 50.01' 50.02' _ .1 LOT AREA 9,588 S.F.f 21.3' 34.9' Z N / / v � O N O v C; EX. O 1 O GARAGE 37.2' / / O 0 i � O i 14.0' co cn EX. 1 1/2 STORY o WOOD FRAME o STRUCTURE O M M 1.0' 38.9' 36.9' Prop. Porch Extension 19.4' 19.8' 7' x 8' 1 Ex. Enclosed Roofed 100.00' OWNER INFORMATION: Porch (7' x 16.25') S63'00'00"W MARTIN ALLEN To be Razed. New Enclosed Porch to be H E M 77 q VEN U E 31 HEWITT AVENUE built in some footprint NORTH ANDOVER, MA 01845 & extended as shown. I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED PLOT PLAN OF LAND BY AN INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN. #31 HEWITT AVENUE NORTH ANDOVER, MASS. I OF PREPARED BY: JOHN D. SULLIVAN III, P.E. 22 MOUNT VERNON ROAD No.41586 !3972 ` 4r `4 f� BOXFORD, MA 01921 N 978� °'��t � � ) 352-7871 2 7871 SCALE: 1 "=20' DATE: 4/10/14 ZONING INFORMATION: ZONING DISTRICT : R3 ASSESSOR INFORMATION: MAP 60C LOT 47 DEED REFERENCE: BOOK: 12965 PAGE: 282 N61'51'15"E N64"43'06"E 50.01' — 50.02' LOT AREA 9,588 S.F.f 21.3' 34.9' Z N O N 1 o EX. o O�37.2' / , GARAGE o � o 14.0' rrl cn EX. 1 1/2 STORY o WOOD FRAME STRUCTURE o M i #31 1.0' 1.0' 38.9' 36.9' Prop. Porch Extension 19.4' 19.8' 7' x 8' � I Ex. Enclosed Roofed 100.00' OWNER INFORMATION: Porch (7' x 16.25) S63°00'00"W MARTIN ALLEN To be Razed. New Enclosed Porch to be H E M TT A VEN U E 31 HEWITT AVENUE built in some footprint NORTH ANDOVER, MA 01845 & extended as shown. I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED PLOT PLAN OF LAND BY AN INSTRUMENT SURVEY A EXIST ON THE GROUND AS SHOWN. 3' HEWS T T AVENUE OF O NORTH ANDOVER, MASS. PREPARED BY: a OH ©� JOHN D. SULLIVAN III, P.E. G.4`l11 �88 22 MOUNT VERNON ROAD u N BOXFORD, MA 01921 (978) 352-7871 SCALE: 1 "=20' DATE: 4/10/14