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HomeMy WebLinkAboutMiscellaneous - 324 BEAR HILL ROAD 4/30/2018 (2) 324 BEAR HILL ROAD 2101064.0 0109.0000.0 \ 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 8 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_imalidifhe—. ._ 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 pemrit 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 1_73 of Chatter 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. le 8—Permit/Date Closed: J- j �C� Note:Reapply for new permitV ermit Extension Act—Permit/Date Closed: /Z— Date......:.. .......%..... f NORTH 1 ° t"`° '• "° TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING 1 i i i AcHusE� Thiscertifies that ........ ....................:e- .......................................... has permission to perform .... :.: .:. '...... wiring in the building of...... ......r............................................... at....--;....:!................................................................ .North Andover,Mass. Fee..— ...... r.... Lic.No.............. .............. .�........... '� LECTRICAL INS CTO -� Check # 4 ci 'J Commonwealth of Massachusetts Official Use Only 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 Code(MEC),527 CMR 12...00----'j' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: City or Town of. NORTH ANDOVER To the Inspector of Wires:,,-' By this application the undersigned gives notice of his or her intention to perfo the electfi'eaal vCWork desdribed below. Location Street&Number / Owner or Tenant fJ d G ¢�7—qh.e— Telephone No.97.$-- 4p-3_,,C/�/ Owner's Address gam f r Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building_ J&A /Jnr•-. Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:/ � �• !�. _ � J �Ylo. � o .. /.r.- elccv. /h-e r2 V orj r /It Completion o the ollowin table ay be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMSNo.ofZones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices " No.of Ranges No.of Air Cond. ons TotNo.of Alerting Devices S No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained l 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 E uivalent M1 No.of WaterNo.KW No.of No.of Data Wiring: 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 Wires. Estimated Value of Ele tri-al ork: 00 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability i surance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. ` CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under thepains an penalties of erjuty,that the information on this application is true and complete. FIRM NAME: r.s , _ LIC.NO.: Licensee: /c/� ,�lr Signature LIC.NO.:(Ifopplicafj�/adY Address•ble,e tgr"exempt rytl�e license nurF{b�r line.) Bus.Tel.No.:7JLl 8 .�— 3_s??4 Ye g//T1 t� JT � �+ r � ,� Alt.Tel.No.: *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 Telephone No. PERMIT FEE: $ . p ? f The Commonwealth of Massachusetts Department of Industrial Accidents ' i Office of Investigations 600 Washington Street Boston MA 02111 www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A6plicant Information /—� Please Print Leaiibl Name (Business/Organization/individual): Address: �� -� S City/State/Zip: -, k fy p-. �4 Phone#: . 9 7 o� 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 1 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.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an workers' com insurance. y capacity. p• 9, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑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.]t .employees. [No workers' comp. insurance required.] ME]Other " *Any applicant that checks bort#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. f 1 ;Contractors that check this box mustattaahed an additional sheetshowing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isprqviding workers'com pensatan 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 f ce Covera verification. I do hereby certify i an pen 's rju that the information providedaboveis tue and correct Si ature: Date: e✓tt'� CX` �G G a Phone#: ��� 'f a Official use only. Do not write in this area,to be completed by city or town offciaC City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other C \ Contact Person: Phone#: 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 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),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 cavy 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 provrled to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each., year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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 Tel. #617-727-4900 ext 406 or 1-&77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.tnass.gov/dia . , J 1 NORTH TOWN OF NORTH ANDOVER OFFICE OF F BUILDING DEPARTMENT Cott s# 1600 Osgood Street Building 20, Suite 2-36 �.'�;;..;::► North Andover,Massachusetts 01845 1s-AC Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please pj' t DATE: JOB LOCATION: 3 aE j2-aAr ` Number Street Address MaP/Lot HOMEOWNERI � ww1�[j Name Home Phone Work Phone PRESENT MAILING ADDRESS-- ,1, 3Z (�( City Town State Zip Code The current exemption for"homeowners"was extended to include owner-oocupied dwellings to two units or less Mid to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINTITON OF HOMEOWNER Persou(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption 130_\RD OF \PPF 1I.S 68&9511 CO.NSERVAFION 688-9530 ITE.\LT1i 688-9540 PL.LNNING 688-9535 Date.`. . . ..CJ... .... a a NON1M pf16 TOWN OF NORTH ANDOVER «ao ,e, 0 0 '_ h`p PERMIT FOR GAS INSTALLATION S.ICHU5Et�y This certifies that . . '" '" . . . . . . . . . . . . . . .. . . . . . . . . . . . . has permission for gas install tion . %� �,• �. . • • • • • • in the buildings of-r�� . . . . . . . . . . . . . . . . . . . . . . . at t �. .� '`-. North Andover, Mass. Feed. . . . . . Lic. No.. . . . . . . . . . f . .`-`''.y?; ,,. . . . . . . GAS INSPECTOR ` "/� WHITE:Applicant CANARY:-Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print orTy�� er , Mass. Date 20 Q� Permit# 31//// Building Location liar W3 L 'Q,.l Owner's Name Telephone�9`j ���_ �yUq Type of Occupancy New Renovation Replacement El Plans Submitted: Yes Nob a a N c d c � oe d d E *98M E = as In ° m` o Z` o D °o c m y _ R 12 o CM CCi m E = m d N O C o C e O N r = 0 2 U. D O 0 -i U W ° O ICL if° O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name EnergyUSA Check one: Certificate y Address 500 Myles Standish Blvd. X❑ Corporation 115C Tauton,MA 02780 Partnership _ Business Telephone (800)822-1300 x8051 Firm/Co. _ Name of Licensed Plumber or Gasfitter William Kent Corson INSURANCE COVERAGE: EnergyUSA has a current liability insurance policy or its substantial equivalent,which meets the requirements of MGL Ch.142. Yes Xl No n If you have checked yts,please indicate the type of coverage by checking the appropriate box. A liability insurance policy - X❑ Other type of indemnity El Bond El . OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above 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 provisions of the Massachusetts State Code and Chapter 142 of the General Laws. Type of License: By MPlumber Title lGasfitter Signature of Licensed Plumber or Gasfitter City/Town X❑Master APPROVED(OFFICE USE ONLY) Journeyman License Number 3707 BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR a Q � NEW ENGLAND CLAIMS SERVICE, INC. ReplyTo ❑ Reply To 0" Reply To ❑ P.O. BOX 345 100 CONIFER HILL DRIVE, SUITE 308 P.O.BOX 578 MANSFIELD,MA 02048 DANVERS,MA 01923 SHREWSBURY, MA 01545 TEL. (508) 337-8058 TEL. (978) 777-9900 TEL. (508) 842-3995 FAX (508) 339-5835 FAX (978) 774-9296 FAX(508) 842-7510 TO— Form O Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3D 2003 APR 4 TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen _n addresses RE: INSURED S�YJ-'q PROPERTY ADDRESS 3 �-4 $f!�a 1Lx_ QA-Z�, POLICY NO.: LOSS OF: �-- FILE OR CLAIM NO.: ,?-)a ">b pb57 Claim has been made involving loss,damage or destruction of the above-captioned property which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3D is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. TITLE On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. c SIG ATUR AND DATE cc: Fire Dept .