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HomeMy WebLinkAboutMiscellaneous - 32 BOOTH STREET 4/30/2018 (2) 32 BOOTH STREET 210/098.C.01 1.0000.0 Date... J� �!................... - �� TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING s E:, gsACMug� 4, F, k This certifies that ............... y..n'`j......................... ......t.-.......................................... has permission to perform ................................................ wiring in the building of....... ....... .... ................................... .. . .................................. at ; .....................2U7"� ....,North Andover,Mass. .............................. r / Fee........'.��.................Lic.No/.a .... '.d' ............. .. . . ...... ELE AL INSPECTOR Check# Commonwealth of Massachusetts Official Use Only/ Department of Fire Services Permit No. 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 W9,527 C 12,00 (PLEASE PRINT RV HK OR TYPE ALL MFORMATIOA9 Date: 3 / / /(( City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice f his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant }t"'I L ra Telephone No. Owner's Address B 00 Is this permit in conjunction with a building permit? Yes �No ❑ (Check Appropriate Box) 3 Purpose of Building f e- S o 17-e/►-'!i L 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 Work: , A00 le" k eC C-SS Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' No.of LuminairesSwimmin Pool Above ❑ In- ❑ o.o Emergency Lighting 7 g rnd. rnd. Battery Units No.of Receptacle Outlets = No.of Oil Burners FIRE ALARMS No.of Zones 3 No.of Switches No.of Gas Burners No.of Detection and v 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 d No.of Dishwashers r Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent 4 o.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: S Attach additional detail if desired,oras required by the Inspector of Wires. c ( Estimated Value of Electri al Work: '�C>© (When required by municipal policy.) Work to Start: , o /G Inspections to be requested in accordance with M � EC 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 O 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:) t certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAM: _ LIC.NO.: Licensee: Signature LTC.NO.. E 3o (If applicable,enter ,gxempt"in the lic nny�e naimber Itne. lA / us.Tel.No.• 611 Address: ks-5 /��I-z�It D $)V VVoS7 �ivn i — Alt.Tel.No.: 1 oZ *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Tele hone No. PERMIT FEE:$ �'e-- 2 l� d �? S 12-1 co IL. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the I1 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed f 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. ❑ 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 certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,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 permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed❑' Re-Inspection Regbired($.)❑ ..... " Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass n Failed IN Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: " Date: ROUGH INSPECT N: Pass 1E Failed Re-Inspection Required($.) ❑ Inspectors Co e Inspectors Signature: Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: ^it eL L/ Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofMassachuse its Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organizatiowbdividual): moi✓ �}���= Address: City/State/Zip: o Phone#: 61'7 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I ' 6. ❑New construction ployees(full and/or part-tune). have hired the sub contractors 2. I am a sole proprietor or partner- listed on the attached sheet.# �• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g• E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3111 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.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I-Homeowners who submit this affidavit indicating they Elie 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 their workers'comp.policy information. lain 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.9: Expiration Date: Joti 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 requiredunder 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 DTA for insurance coverage verification. Ido hereby cerdh under thepains and penalties ofperjury that the information provided above is true a correct. SiMature: // Date: -� C 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#: Q i Information and 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 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 ,, pbe deemed to be an employer.,, er. py 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." Applicants Please fill out the workers'compensation affidavit on . p v� completely,by checking the boxes that apply to your situation and,i £ necessary,supply sub-contractors)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'compensation insurance. If an LLC or LLP does have employees,a policy is required. 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 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 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. Anew affidavit must be filled 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 bum leaves etc.)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: The Come-gonweaithofMassacl.vsPtts Department of Industrial Accidents Office ofInvestigatlons 600 Washington Street Boston}MA.42111 Tel,#617-727,4900 ext 406 or 1-877:MASSAFF Revised 5-26-05 Fax#617-727-7749 wwv�an:ass,go�fdia SETTS COMMONWEALTH OF MA SACHU Baarn F 'ELECTRLC I ANS SES THE FOLLOWING 'LICENSE AS W I.SSI REGFI:S7ERED MASTER -1r LECTR:_I*CLAN DC7 . D8A MARIE ELECTRIC _' BRYAN HART]s Jaxt., i iW 155 STRATFOf2D ST Ss 1, JP 1 ,� WE57 ROXBURY M`A 02132 2137 91013 07/3.1 J �a MMONWEALTH O . F MASSA HUSETTs BOAR>n OF ELECTRICIANS., ISSUES THE FOLLOW NSE INR t10E Rpt; OURNEYI�A s =---., . ELEGTRI,C1r� ' B,RYAItI W HARTS a 1155 STR'A1Lu ;r ..1 D ST r � Z ROXBURY M 021 2 21 . ' t 3 37 0 ! E 1116 10 F i Town of North Andover Your permit has been sent back to you for the following reasons: 1) Check amount incorrect 2) No copy of current license 3) Insurance Binder not on file or expired V/ 4) No Workers' Compensation Insurance Affadavit Form Please call with any questions 978-688-9545. vl o Workers'Compensation Form and Schedule of Fees can be found on the Town of North Andover Website under Building Department. 1 y i Date.. ....t.. .�. . .......................... �HonrH, TOWN OF NORTH ANDOVER F � 9 PERMIT FOR GAS INSTALLATION •F 8s.+cMus� This certifies that ... 11 .... fAt�+NI� VtGrv�._ ............................................................................. has permission for as installations P gas ....................................................................... inthe buildings of....:` '2... ..................:............:............................................................ 22 C at.................................................................................................. North Andover, Mass. FeeZ. ....... Lic. No. .15 ` .............................................................. GAS INSPECTOR Check# 910 t. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ® CITY North Andover MA DATE 112812014 PERMIT# JOBSITE ADDRESS 32 Booth St OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL', ..i EDUCATIONALi RESIDENTIAL;✓ CLEARLY NEW RENOVATION Y✓Y REPLACEMENT: - PLANS SUBMITTED: YES i N0: APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR `T FURNACE GENERATOR (� GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT Q6- OVEN LOVEN 1 POOL HEATER ROOM 1 SPACE HEATER f ROOF TOP UNIT I' TEST UNIT.HEATER `S UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabilitLinsurance policy or its substantial equivalent which meets the requirements of-MC!.Ch. X42 �YES—✓. NO IF YOU CHECKED YES,PLEASE INDICATE M iP.ri--�+=3r Gov rt o�8 .:,^",;1ECw� TKA�:at or_rawrt_-'BD7�BELOW... LIABILITY INSURANCE POLICY ✓ OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have th-.in urance'r-o4er'de required by Chapter 142 ofthe Massachusetts General Laws,and that my signature on this permit application waives this requirement. C s CHECK ONE ONLY: OWNER AGENT 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 and accvpte to the besnowl t of y kedge ` and that all plumbing work and installations performed under the permit issued for this application will be in compliance II Pertinent p ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME Brian Cunningham LICENSE# 15515 SIGNAT . _j LPGI CORPORATION # PARTNERSHIP, # LLC ✓'#355 MP'✓ MGF JP JGF .�- COMPANY NAME:BC Plumbing&Heating ADDRESS 266 East St f CITY Dedham STATE MA ZIP 02026 TEL 781-726-2270 FAX CELL EMAIL Bdan3psi@me.com 14 , -e.---c-Ij L:�)- Vin ,A-, i r f ti s" ° e'C'ommonwealth of Massachusetts - t� Department oflndustriol Accidents } Office of Invesfigations, 1 600 Washington Street Boston,MA 02111 a ' www.massgov/dia Workers' Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Inform'atlon Please Print Ledblv P Name(Business/Organi'zation/fmdividual).-9 0 (� Address: h City/State/Zip: lied&[M ,mk Phone#:_ Are you an employer?Check the appropriate box: Type of project(required): _1.b( I am a employer with 4. ❑ T am a general contractor and I - 6. [}New construction employees(full.and/or part time).* have Bared the sub-contractors 2.❑ I am a sole proprietor or partner- Jiked'on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. []Demolition working for mean any capacity. workers'comp.insurance. :9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 0.❑°Electrical'repairs or additions required.] officers have exercised their �.1 3.❑ I am a homeowner doing all work right of exemption per MGL 11A Plumbmgrepairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.❑Other comp.insurance required.] I 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 2're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. X am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. - A-M'4 �NsuMNCG C-,omokm4. Policy#or Self ins.Lic.#: C.) b0coakN ExpirationDate: Job Site Address: ✓a aCity/State/Zip: - N W V eY Attach a copy of the workers'cornpensationpolicy d"claration page(showing the policy number and expiration date). Failure to secure coverage as required-under Section 25A of MGL o. 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 eforwarded to the Office of advised that a co of this statement may b � " st the violator. Bev of up to$250.00 a day again PY Y _ • . a Investigations of the DIA for insurance coverage verification. X do hereby certi rider the ins and penalties of perjury that the information provided above `iIs true and correct. Si afore: Date: I i Phone#• _ �L 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#: �- C I Fa•�ly aic I :. ,� ,'� .� 'r�.:.7rcS"`.-'-:�',I--ja,�' "'`,' Csy_,�ry,��,y��,� �• �t+`,� ��er�ll`y-�ctifL:�� r•'7. � a 71�/�¢E4fl�firl7r A�,iY 4- ,T i 1�IS Y+r�'y :: •'{�'•:c'Cci;,,;,...Mry;(. r• :1,ra''`r,,}4 a � \ •Ty� i.�':?,f�;l'-T'�Jrl^,.:.:, •:.,' I` "N.W. �±"�'. x � X,, �; 'rTi;;`:'i�.may::✓•h;: 4i. �:, '��Y. ..: ,•, �� 1: 4,,{ ,., 7u,-r-•-r-%'o ✓:::•.r Hm ;rr. 1•+.;�'A}•"�'sAY"Df��+u�.._:i•'�!)t t'6''r: H„_ , <.;,. ��'_ rr^ l:M � '•+w�•' 4 r` •�_"•j"�..cl'._rr t'3'•Er�, ..'y4rt�,,•,�..i" •:�`^s, n.: .y:t:�' �' �. r ��i ti.:,-.:_;:rFs l�",N-� _�:^ ...;r�. `L_� t"�' '''•Yrei�T- " Wl ln:.Y,�j� !J '!Y 9z-�`•.' "r• r •�T• :;h• o.:rw,�...;rbra:,�5'�'•.::r-�^:���'='"'a°''"�"`� ,+W"M , I ..��r s=irr�.; �' .�L.w�`1.'rY.= svo.�•j: '�j,�--k'ji .w`_-i',�'d;:•:--^�-.: n v"•,� �"ti •4'c�A{it`r�:'u,:�""�'�:'p °r�=F - 'j:.._,: .,..i.�c,,::a r q f ,C•a �. r-'J•.. "�=:= Thr __.. �_1.a._a:<f f `� f T..qtr .i.�..• �.� �,���,�� Y""Yc".c:::+-�•`=i'+,=_:' � i�Ci:.i�:l�'".^�_'�iL'<��.��,�uu{{'�l_�i k f. '� •t ^,AA� ��"•��jP'�JI:.Y;:�F.. 1'li ' iC:� -•".SSC- ~• h T 9:r•:'; "t' 0 '•{�':'_'�i ,y�I ky",�! i+�u '•c' ''L•.� � y=e/= •Vin,�. � �:I ... c� _Q t �. fir:�. •• "+••rti �... 3tN7 f ;, ;_K°.._�EEit=w.' z.:"' `rtF-Z 4__y, 1•: ' at 'fttp://www•mass.gov/dpl/boards/PL t BRAIN CUNNINGHAM BC PLUMBING & HEATING LLC (PL) 266 EAST ST DEDHAM MA 02026-2049 t IMPORTANT NOTICE PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE OFFICE OF THE STATES BOARD. Fold,Then Detach Along All Perforations t t co- r� k n i'S P`LL�MB�F(S �+ �Y SF�ITT�RtS t r PY:^• t(�S UJyll $`"*I���kL.� k,P� I4Lf�ty y ''zr.Y Pd tru-1�d vi4- "5 F-Ou^n,1.1Y XS L gkt J_ i bs�AS,4K ft-', V 69A Y BRA'l'�l�j"CUNt�;i►�Gyt�� k r t�'rt`, + C�PLM�ING ,, H`EATyIIG OEi~EAMx x, ° '' 2026,2.049>r 3t w..>'F 7 i Location No. Date I r k TOWN OF NORTH ANDOVEJ'; i Certificate of Occupancy $ Building/Frame Permit Fee $ `^ Foundation Permit Fee $ Other Permit Fee $ { TOTAL $ F. f;. Check#✓ 27244 Building Inspector