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HomeMy WebLinkAboutMiscellaneous - 32 SAMUEL WAY 4/30/2018 BUILDING FILE r Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . 1. !!�� .. . 4 G71 c has permission to perform . . .dyQ w . Cq- wiring in the building of . . . . . . . . . . . . . . . . . . . . . . . . . . at . . 3z. . 5n-��<? . . ( /4 5!. . . . . . . , rth Andover, Massa Fee . Lic. No. ., -'� / . . . . . ELECTRICAL INSPECTO Check# I D S 11227 N Commonwealth of Massachusetts official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank 'M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: hA-� City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives ti of his o her intention to perform the electrical work described below. Location(Street&NMa Owner or Tenantu ,r Telephone No. Owner's Address Is this permit in conjunction w h a u>>ding permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Q V1 I 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: Completion of thefollowing 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- ❑ 1VOT-OTEmergencyLighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No,of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices Heat Pump Number"Tons" KW,"........ No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElMunicipalConnection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs - Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of 97res. 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 tlt ains and penalties of erjury,that the information on this application is true and complet FIRM NAME: . @(, i j LIC.NO.:a Licensee: VVSignature LIC.NO.• ) �Q ,Q g Address applicable`,,e llexem��in the tn�'nu b r li .) Ni �� Bus.Tel.No.: I ) [� h � Alt.Tel.No.: I{ *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 PERMIT FEE. $ Signature Telephone No. ❑ 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. ❑ 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 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ ' t.i Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ i. Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: kln ass ? Failed ?❑ Re-Inspection Required($.) ❑ specto Comments: Inspectors Signature. Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com w 4 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 111 - Phone#: U Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a em toyer with 4. El am a general contractor and I employee and/or part-time).* have hired the sub-contractors 6. El New construction 2.ds am a sole proprietor or partner- listed on the attached sheet.# E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition t orking for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.[ Electrical repairs or additions - uirefficers have exercised their p ;�q Al] 3.❑ slam 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.]i employees. [No workers' comp.insurance required.] 1311 Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. am an employer that is providing workers'compensation insitrance for my employees. Below is the policy and job site :formation. isurance Company Name: olicy#or Self-ins.Lic.#: Expiration Date: :)b Site Address: City/State/Zip: .ttacbaa copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 Pup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. i do herebertify under the r and enalties of perjury that the information provided above is true and correct. I i ature: Date: 4 zone#: 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 i l 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 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." Applicants r Please 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' 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. 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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 evised 5-26-05 www,mass,gov/dia i✓ gOTM �M10 N•� C N CERTIFICATE OF USE & OCCU C PAN Y TOWN O,F NORTH ANDOVER Building Permit Number 491 (3/17/09) Date: October 21, 2009 THIS CERTIFIES THAT THE BUILDING LOCATED ON 32 Samuel Way Unit B MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement Community 575 Osgood Street North Andover Ma 01845 Building Inspector Town of : t Rdov' er . No. y q l - - 71 11Z 7 ItI9 � o =� L A K E dower, Mass., COCMICMEWICK 7�A�RATE0 `s BOARD OF HEALTH PERM. IT T D Food/Kitchen Septic System fi -a ,00` W! , SPECTOR THIS CERTIFIES THAT.......,�.C.. ... .......C. s........... ................................... oundatio has permission to erect.. ....... . gs on . ... ....... • Chimney to be occupied as.............. ........... .... .. .f' ..4.................�TT .,�r..... ......................................... ........................... provided that the person a epting this per shall in every res�ct conf rm to the terms of the application on file in final this office, and to the provisions of the Co es and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PL ING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 61a1 0-1 Final � /Ci � ) PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR INSPEC OR 0 UNLESS CONSTRUCTIO ARTS ....................... ......................... ....... ..... .. .............................. Service BUILDIN� INSPECTOR Occupancy Permit Required to Occupy Building GAS C INSP R Rough �G% ��� Display in a Conspicuous Place on the Premises — Do Not Remove na No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. C SEE REVERSE SIDE Registered Architectural and Engineering Services Construction Control Affidavit Project Number_ DSA Project#0706.00 Project Title: Edgewood Retirement Community Cottages Project Location: #32 Samuel Way,North Andover,MA 01845 Scope of Project: 22 Individual Cottages In accordance with Section 116.0 of the Massachusetts State Building Code I,Allen Dewing Jr.,MA Registration #4301 being a registered professional engineer/architect, hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: . Entire Project xi Architectural Structural Mechanical Fire Protection Electrical Other (Specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code. All acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2. 1. Review for conformance to the design concept, shop drawings, samples, and other submittals,which are submitted by the contractor in accordance with requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. Upon completion of the Work, I shall submit a fiYae r, as to the satisfactory completion and readiness of the project for occupancy. � f, .�'� ,�.m QCT ���YdPZGT�C'�y n No.4301 yOf r Low COCOidD, lien ewin Jr. Q KA a X47(?FAADS F:\DSA Project Files\Edgewood 0706\05. Project Word Documents\a. Correspondence and Transmittals\vi. Misc v Registered Engineering Services Structural Construction Control Affidavit at Completion of Structural Work Project Number_ DSA Project#0706.00 Project Tide: Edgewood Retirement Community Cottages Project Location: #32 Samuel Way,North Andover,MA 01845 Scope of Project: r Wood Framed Cottage with Concrete Basement and Foundations In accordance with Section 116.0 of the Massachusetts State Building Code, I, Geoffrey S. Conway, MA #32753 being a registered professional engineer(structural),hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project Architectural XX Structural Mechanical Fire Protection Electrical Other (Specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I have performed the necessary professional services and have been present on the construction site on a regular basis to determine that the work is proceeding in accordance with _ the documents approved for the building permit and have been responsible for the following as specified in Section 116.2. 1. Review for conformance to the design concept, shop drawings, samples, and other submittals,which are submitted by the contractor in accordance with requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required materials. 3. Been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine,in general,that the work has been performed in a manner consistent with the construction documents. OF Mgssq� Geoffrey S ay, P.E. Date �� GEOFFREY yep � S. CONWAY e�a� O STRUCTURAL v No.32753 .a90�ss GIST�� CONAL f NORTH 0 RD � tt osrrs 'r bA4rto ,ss^`""SES APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit# ADDRESS/LOCATION OF PROPERTY :,12 Map Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION 6 CLOSING DATE ON PROPERTY: FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00) WILL BE.CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. f"C:rmiL Issued tv: Address SIGNED ROU NG CONSERVATION PLANNING © oji"/©q DPW-WATER METER SEWERMATER CONNECTION �D q NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature File: Application for OC form revised Jan 2007 ra NOR1N CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 489(3/17/09) Date: October 21. 200 THIS CERTIFIES THAT THE BUILDING LOCATED ON 36 Samuel Way Unit B MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued t0: Edgewood Retirement Community 575 Osgood Street North.Andover Ma 01845 �j Building Inspector NORT►y c Town of t _ Andover O .,.M•per l'�'�'•4` .�` ` No. y over, Mass., �� O COC IC EWICK y�t 7,e AORATED S E BOARD OF HEALTH Food/Kitchen PERMIT D Septic System INSP C OR THIS CERTIFIES THAT.......... .. .......... Ixoundatio . C i has permission to erect........................................ buildings on ..36.......,5.�'.( ough to be occupied as...........r� (c2q ' 1..:6`............ .(� y�? :. ��............................................................................... imney provided that the arson acceptin thi ermit shall in ev6 respec conform to the terms of the application on file in P P g r!I P pP the provisions of tlfe Codes and By-Laws relating to the Inspection, Alteration and Construction of this office, and to p � 9 Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough �- Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS on &Y� �..t%`*' ...,/�... Service BUILDING INS ECTOR Occupancy Permit Required to Occupy Building GAS INSPECTO Display in a Conspicuous Place on the Premises — Do Not Remove in`�, �, ©� No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. E 1 D E Smoke Det. SEE REVERS S q s Registered Architectural andRegistered Architectural and En ' eering Services Services Construction Control Affidavit Project Number_ DSA Project#0706.00 Project Title: Edgewood Retirement Community Cottages Project Location: #36 Samuel Way, North Andover, MA 01845 Scope of Project: 22 Individual Cottages In accordance with Section 116.0 of the Massachusetts State Building Code 1,Allen Dewing Jr., MA Registration #4301 being a registered professional engineer/architect, hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project "11111_Z Architectural Structural Mechanical Fire Protection Electrical Other (Specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code. All acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2. 1. Review for conformance to the design concept, shop drawings, samples, and other submittals,which are submitted by the contractor in accordance with requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine,in general,if the work is being performed in a manner consistent with the construction documents. Upon completion of the Work, I shall submit a final re ort as to the satisfactory completion and readiness of the project for occupancy. R�D ARC � OEW/,I,Gr'��i� a No.4301 CONCORD, /eAnDewing*'Jr. Now - FADSA Project Files\Edgewood 0706\05. Project Word Documents\a.Correspondence and Transmittals\vi. Misc s Registered Engineering Services Structural Construction Control Affidavit at Completion of Structural Work Project Number: DSA Project#0706.00 Project Title: Edgewood Retirement Community Cottages Project Location: #36 Samuel Way,North Andover,MA 01845 Scope of Project: Wood Framed Cottage with Concrete Basement and Foundations In accordance with Section 116.0 of the Massachusetts State Building Code,I, Geoffrey S. Conway, MA #32753 being a registered professional engineer (structural),hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: g Entire Project Architectural XX Structural Mechanical Fire Protection Electrical Other (Specify) For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I have performed the necessary professional services and have been present on the construction site on a regular basis to determine that the work is proceeding in accordance with the documents approved for the building permit and have been responsible for the following as specified in Section 116.2. 1. Review for conformance to the design concept, shop drawings, samples,and other submittals,which are submitted by the contractor in accordance with requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required materials. 3. Been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine,in general, that the work has been performed in a manner consistent with the construction documents. OF Agq�s Geoffrey Way, P.E. Date o GEOFFREY yG S. CONWAY nr 0STRUCTURAL -i No.32753 y C IST NAL FSS/ONAL��� V10 TF1 4.0 Of Sao i 1ti t t � ` C►+us APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit# Z ADDRESS/LOCATION OF PROPERTY : Map Parcel Lot Number SUBDNISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: _FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. ('"el n-1II Issued to: Address SIGNED ROUTING Fv71 CONSERVATION 10 0-1 0 PLANNING m//`'/e, DPW-WATER METER q�j00 SEWER/WATER CONNECTION FT, �10Q NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY(INSPECTION REQUEST DPW 6al,4 Signature Fife: Application for OC form revised Jan 2007 Date..... TOWN OF NORTH ANDOVER 0 4t PERMIT FOR WIRING ACHU This certifies that ... .... ......... .... .. ... . ....................... has permission to perform .....A#110--r ....................... wiring in the building of.......... . .................................. !v e7 ......................OA51 Andover,rvA- Mass. F ................... .North . ..... . ........ Fee.. L""'-"Lic.N o. ..... ELECTRICAL INSPECTOR/ Check # 8714 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. F7 G� Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS v. 1/07] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfarmed in accordance with the Massachusetts Electrical Code(MECO,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I-/- Z- - City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work descnbed below. Location(Street&Number) 3 ;k &nud " Owner or Tenant Telephone Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No ❑ (Cheek Appropriate Boz) Purpose of Building ,ge S,yam., f/is� Utility Authorization No. Eristing 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 Co lesion o the ollowin table be waived by the Lnx pector of Wires. No.of Recessed Luminaires No.of Ceil.-Snap.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Lnminsies Swimming Pool dve ❑ ❑grnd. , Ba•o ency un .� Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners N—o­of Detection an Initiating Devices No.of Ranges No.of Air Cond. Toots tal No.of Alerting Devices No. of Waste Disposers eat �P r one o.o ontain Totals Detection/ Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connetion No.of Dryers Heating Appliances KW ec�ty ` Na of�or Equivalent No.of Water , o.o S' o.o HData Wiring: Heaters y s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total HP ecommunicationa tNo.of Devices or Equi OTHER: Gj Attach additional detail ifdesired, or as required by the Inspector of Wires. Estimated Value of Electrical Wo �a/.--I F a0 (When requires by municipal policy.) Work to Start: �/'-Z/-� 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 cow a 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 and penalties of perjury, that the information ort this application is tree and complete. FIRM NAME: .5'a vG /7fd l�►i/l LIC.NO.: 84-5 Licensee: eo k- ,J{ & -S'✓!/i ve n Signature `_ LIC.NO.: -2 2 V 7J (If applicable, enter "exempt-in the license number line.) Bus.Tel.No. --Ty 7y Address: -277 Af l o C givQ S7: C4wx,6VCE Alt:TeL No.: 'Per M.G.L c. 147,s. 57-61,security work requires Department o 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 Telephone No. PERMIT FEE. S ti t 1,2 1-L a Y L ` The Con wion weam of MassaC/1ILSelt'ts j - Department of Industria!Accidents J Office of Invesdgations f?S 600 Washington Street Boston, MA 02111 P www.ma=g ov1dia Workers' Compensation Lisarance Affidavit: guilders/Contnctors/Electndins/Piemberr, !Policant Ltformatma Please Print Ueffily Name (Business/Organization/Individusi):_ >� f/0 /j�n 10,r)&4f /T/0 Address:_ .,L City/State/Zip: Phone#: . cl 7J- G Are von an empbyer?Check.tbe appropriate box: Type of project(requir*: 1.[f I wn a employer with 4. ❑ 1 an►a general contractor and I 6. Now construction employees(full and/or part-time).* have hired the std-contnieors 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet.t 7 ❑Remodeling ship and have no employees These sub-coritractors have 8. Q Demolition working for me in any capacity, workers' comp.insurance. g Q But7ding addition (No workers' comp. itsstusrtce 5. ❑ We are a corporation+and its 10.[3 Electrical repairs or additions required.) offrcem have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MOL 11.Q Plumbing repairs or additions myself [No-workers' comp. c. 152, §1(4),and we have no 12. Roof insurance required.]t -employees. [No worker' ❑ 13.E]Other comp. insurance tequired_j Arty stspii=w then Checks bob X 1 muse also�t ow um section below showing their workas'compensstice poiiey Mftnnutioa t homeowners wbo submit this affidcvit wdna ting they ate doing in work and am hos outside eerascun must ssrbmit s aew afBdevit irdicz*aW. 4Coatraetors that drodc this box muaxbdrod as ad&tiaosl sheet shower the aeon.of the and tbec worm•Cec*p PoliCY . arts nit esrployeT ih�is p�»vidurg:Mrorkers'�wupeuremion tnsurancefornty.a eex Below is the po6ey andjob site information. // Insurance Company Name: G,a n fV �a Policy#or Self-ins. Lic.#: W6-(L 3,�9 S9 Y ap;tm,Date: Job Site Address: 3Z. J��t-��(�/ �✓G' Citya te/Zip: Attach a copy of the�yorkerV empensation..policy declaration page(showing the policy aamber and expiration date}. Faihnti to s=re coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 3 fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the ftsm of a SMP WORK ORDER and a fine of up to 5250.00 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. do kereby c under the WesoIfemuy that the mforn adm provided above a true and coned 5i Phone#: 9 7 S-�- G 6PL (D Y 7 y [ .075 1 use only. lb not wrae is this area,to be conpletzd by c ty or town officioL City or ToPose# Issuing ALdherity(circle one): 1. Board of Health 2 Bau'l&ng Dep=ttneent 3.Cityrfow zClerk 4.El—trial inspector 5 Piumbmg Inspector 6.Other Contact Person: Phone Date........................ .... ,iORTI� Of t�.i°ie,ti r ,•,� -- ._fie co . TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SS�cHusE� This certifies that ..... .................... ............... :�...... has permission to perform ..... wiring in the building of...:. - -�� at.��..._........ ... . ...... North Andover,Mass. tiFee. ... ............. Lic. �.......... . .. . .. .. .. .........: .W' Check .. ELECTRICAL INSPE R Check # /D9d 6-9, 869 Commonwealth of Massachusetts Official Use Only QQ r D�� Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank) lug APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC ,527 CMR 12.00 IN (PLEASE PRT IN INK OR TYPE ALL INFORMATION) Date:_ �9)0 9 City or Town of: A),�d)CaVJV z 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) 2,a, 5 a M t AE.Z_ 10 A i Owner orfenent L]' :i Grlon(N'ice Telephone No. Owner's Address S� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ]:)k i)R:'I$ t P6, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service oo Amps 12,n. /7_4O Volts Overhead❑ Undgrd No. of Meters J_ Number of Feeders and Ampacity r ?gQ A M Q Location and Nature of Proposed Electrical Work: 1j liZr A)&) Sim „)k* 611MILy LDJJf,iAJ Com letion ofthe following table mav be waived by the Inspector of YVires. 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 No.of Emergency Lignting No.of Luminaires Swimming Pool rnd. ❑ arnd. ❑ BatteEl Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners r No. of Detection and No.of Switches Initiating Devices No. of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained P Total P .......................... ....................... ....................... Detection/Alerting Devices di 4. Municipal No. of Dishwashers Space/Area Heating KW Local Connection [I Other Heating Appliances KW Security Systems:* +' No.of Dryers No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs JNo. of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Val4offctricalWork: (When required by municipal policy.)Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCERAGE: 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 cov age is in force,and has exhibited proof of same to the permit issuing office. r R (Specify:) CHECI.ONE: INSURANCE [�BOND ❑ OTHER ❑ (Sp fT) application is true and complete. I certify,under the pains and penalties ofperjury,that the information on this pp ip FIRM NAME: Interstate Electrical Servi , s rporat ', LIC.N .:A-5217 Licensee: Pasquale A. Alibrandi Signature I (Ifappl icabl neer "exe n t"in the license number line.) w Bus.Tel.No.:9 7 8—667-5200 Address: �� Tre�ge Cove Rd. , N. Billerica, MA 01862 Alt.Tel.No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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. �. .. s i �, �—� ��� �o-- � o � �, .i. �� �- �. � 1 (� _. f. r Date.(? Ar f, r. TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION CH Ery This certifies that .: !- . . has permission for gas installation . . . , ' . . . . . in the buildings of . .'AL7. C5 .c . ...c:.4. . . . . . . . . . . . . . . . . . . . at .. . . .S� ��: n . . . .. North Andover, Mass. Fee. jeG Lic. No..' 3.Y . . . . . . �..-- _. . . . . GASINSPECTOR Check# &f a 2 , 682 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING ah►/Town• � fi-1y 1-A n �/ iV / MA. Date: Co l� 7� Perntit# Buckling Lotatfoma ! )1MU,e- Owners Name:L`a q e l.)oo� Type of Occupancy: Commercial❑ Educational❑ industrial❑ Institutional❑ Residential New:93'0"'Alteration:❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FDCfURES Ul Z IW Y = {Q� V o X 40 Co t— m = ♦' ullQ W 0 1— 0 W W z I- W fu .00 UE O b o Z V W .Z = W G X W W 0 J tW- F O Z -J ® W = W W W O 0}C Q iY m > 0 Z O W IZu Q z z g o n. a� � aZ> > > o + SUB BSMT. BASEMENT 1 FLOOR i FLOOR FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Cheek One.Only Certificate p Installing-Company Nampa#: P[� � nt�>�rn3rr Addres936 Partnership Business rm/Comp" Name of Licensed PlumbedGas Fitter INSURANCE COVERAGE: ----------- I .__- --I have a current IIaW insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes® No❑ If you have checked Yes please Indwate,the type of coverage by checking the appropriate box below A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVPR 1 am aware that the Iceensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only SWnatijre at Owner or Owner's Aaerd Owner ❑ Agent [3 By checking this box ;t hereby cwdty that all of the deta0s and Inknnatiae 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Imp performed under the penult issued for this application will be In cmnplienee with all Pertinent provision of the Massachusetts State Phmmbing Code and Chapter 142 of the General Laws. Type ense- BY ❑Plumb -rine �Master Sigfiature of UPlumbed Fitter City/Tom ❑Joumeynan License Number 1 `37 1 APPROVED OFFICE USE ONLY) DLP kaftlier Date. . .... . NORTH TOWN OF NORTH ANR - PERMIT FOR PLUM NG • � s This certifies that - `. . .: ?/ . . ... . . . . . . . . . . 7 f 1 has permission to perform �- 7:1). . . . . -.:: . . . : . : . : . . . M plumbing in the buildings of . .��'j �— ... . . . . . . . . . . . . ./. . . . .. at . . -7jr� , - . . . . . . . .... ; North Andover, Mass. Fee/. �:�J Lic. No..'V:'. . . f � ��,?�'%7� . . . . . . . . . . . . a' PLVI B9NG INSPECTOR Check # "� v 8072 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: 1216,4h 4rd6 $r . NIA. Date: ,5Z/q1 j 9 Permit# Building Location: .3 e sc Y Owners Name: S;A- e LcJdr}d 13e1'ire n-t Qrnnl, Type of Occupancy: Commercial❑_ Educational❑ Industrial[] Institutional❑ Residential❑ New:W Alteration: ❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES z z rn O N ILW. z } V W (� W z F- J z W. pC . Z M z F in. O.. ? F ?: In x fR CL Co ~ W W Y to ! J D- w — x a � CL - o a 0 Q . W 00 0 w � w .ma. v a t- F- O 1- -1 — W rL'. 0 3 z a m W W w� v 1z- = tL O w � O j a 0 o 0 Z z W r I- = O > O — a O. W . O x a a a. a. � . a m m 0 0 W O = Y g lr w v, I- 0 3 0 SUB BSMT. BASEMENT t / 1 FLOOR i t 3 / 1 2 FLOOR 3 FLOOR 4 1H FLOOR 5 FLOOR 6 FLOOR 711HFLOOR 8 FLOOR Check One Only Certificate# Installing,Company Name: fllla>nStiel4 Plumbing&Heatilng,lnc__ .2561-C l$ Corporation Geo' etown Address: 36 JaCkman S# __ City/Town: 9 _Stati�-=MA— 0-Partnership Business Tei: (9783352 5493' Fax:{978}3521 541 U ❑-FinntCompany Name of Licensed PlumberTimothy J. ManSfiel INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER:I am aware that the kicensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws;and that my signature on this permit application waives this requirement Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I_have submitted(orentered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: l roue Plumber Sigfiature of lumber Master Cityrrown_ Journeyman License Number. 13`437 APPROVED OFFICE USE 6-N--Ly) I 6 4