Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 400 SHARPNERS POND ROAD 4/30/2018
400 SHARPNERS POND ROAD 7 210/090.6-0047-0000.0 J � Date /13 ..................... ............... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING gsncHU This certifies that ................................................ .. ................................ has perrmission to perform .................. .................................... wiring in the building of ................................................................ at .�.....0. ........ ........ .............I North Andover,Mass. .....................PLEcrRicAL INspwrox/ Fee... Lic.'No. Checkg S 2:s4ga 11793 ' Commonwealth of Massachusetts Offifcial Use Only Permit No. / 7 9�!_ Department of Fire Services Occupancy and Fee Checked aM 6 BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC), 27 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: Y/15-1 R City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention 0 perform the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address d Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building 4Zp Utility Forization No. Existing Service aOO Amps \Zd / 7-4D Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity nom, IC-.Z:- Loc ation 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 Above In- o.OTE mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ BatteryUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burgers No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW_ No.of Self-Contained p 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 KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.$ydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: 'ZJ � A Attach addition detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ections 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 cove pge is. 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 ofperjury,that the Wormation on this application is true and complete. i FIRM NAME: . Q" �J LIC.NO.: � Licensee: '�jp��w,ASignature LIC.NO.: (If applicable,enter "ex mAtt"in the license number line.) Bus.Tel.No.- 751 25_8'—V iG Address: Alt.Tel.No.• *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's 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 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass(] Failed Re-Inspection Required($.) ❑ Inspectors Comments: . I t� Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: } r ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL PECTION: Pass 0KIN Failed 0 Re-Inspection Required($.) ❑ Inspectors Co ts: Inspectors Signature: U I Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA. 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: Phone#:_DSS\ '���Cp 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 9YATdoyees(full and/or part-time).* have hired the sub-contractors 2.LZI am a sole proprietor or partner- listed on the attached sheet.# 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El 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.] 13.❑Other *Any apllicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homedwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:. Expiration Date: Job Site Address: City/State/Zip: Attacll a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failurb 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain dpenalties ofperjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 1 Information and Instrnctions 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 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 C 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 r 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 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: Tho Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFl, Revised 5-26-05 Fax#617-727-7749 www-mass,govldia 10084 D ate /�/1 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Al This certifies that . . has permission to perform . . . . . . . . . . . plumbing in the buildings of. 3� .5-4"'-X at . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee .�- .0 . Lic. No.�fe/,Q. . . c� . . �. . . . . . . . PLUMBING INS ECTOR Check 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE ( PERMIT# �Q JOBSITE ADDRESS WNER'S NAME POWNER ADDRESS S' e— TELFAX } TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES Eq NO FIXTURES 7 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM E _,_,__ __► _ ( ._ _,I ___ i _� __�_,1 ____ ..___-._.1 .—_. 1 ( 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ( _ _J _ _ - - _. _ _( DISHWASHER 1 _ _ ( I i . ..___{ _ .__! f ( __� DRINKING FOUNTAIN _ .-._ . ._I -- - ---__._I _—� 1 I ( 1 FOOD DISPOSER FLOOR/AREA DRAIN _____.� i INTERCEPTOR INTERIOR i �_.._.S _ KITCHEN SINK —( _--__.! _ _.� _._._._� __.__._ t ____ I I _._._S _._.,_ ._ ._._( ____-J __—_ _._-- ( _._J. LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINKi I E=11---i _I TOILET i -( --J if URINAL --° WASHING MACHINE CONNECTION ____� WATER HEATER ALL TYPES WATER PIPING OTHER ___-._._# INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES _ !0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _ OTHER TYPE OF INDEMNITY D BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee 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 F-1 AGENT 01 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 accurate to theest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia =ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# 6Oi IG E IMP EI JP CORPORATIONF]# PARTNERSHIP#L Ii LLC ( COMPANY NAME �1'Zsz� 11 ADDRESS CITY {STATE ZIP �-- -t7 __..__........__. ._. . I `� 11 TEL 7 FAX ]CELL��EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No � 1Y pa.,0 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /J �A�/ 3 FEE: $ PERMIT# PLAN REVIEW NOTES Al a n ry The Commonwealth of Massachusetts - Department of IndustrlqlAcciden& Office of Investigations UV) 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorsfFIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization&dividual): G GZ Q_J Address: �- v v� I f,4 - City/State/Zip..l O S` �¢ (c� Ph.#:C,7 V4 J ? z.- Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I 6. LNew-oonstruction r employees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet.x 7• modeling ship and'have no employees 'These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp.insurance. 9, []Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L ]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.] 13.❑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 ate doing all work and then hire outside contractors must submit a new affidavit indicating such. icontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infonnation. .1 am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert rte liepai s andpe ofp rjury that the information provided abo is tr e and correct, - Si ature: `� Date: Phone 4: � 2 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: r If r t Information and Instruction's 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 ofhire,• 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the cgntracting 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 carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 Eno. City or Town Officials -P-lease-be sure that-the affidavit is-complete-andprinted legibly: The Depaitmerit 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: Tho Cotnmonwealt� ofMiassa.c usetts Department ofJudustdal Accidents Office of%vestigat iolla 600 Washit pit Street Boston? .QZX f X Tel,#617-72,7=4900 ext 406 or t-8,77,NASSAFF Revised 5-26-05 FaY,#617-727-7749 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND G4SFITTERS LICENSED AS A JOURI-OYMAN "t LUMBER ISSUES THE ABOVE LICENSE TO: THOMAS J DE FRONZO 14 CANTERBURY HILL RA TOPSFIELD MA 019L'5- 1522 !( 20160 05/01/14 157186 Fold,Then Detach Along All Perforations � i i I l I V r 1 Date..........1.�-�.....� ...... 10460 pF NOprM,ti TOWN OF NORTH ANDOVER ° n PERMIT FOR PLUMBING gg+cHus� AW, �. Thiscertifies that................................................. .((.. .............................l........................... has permission to perform......................... :T1. l,,5k:...wj.....`1.Z... -- plumb,,��inl!g in the buildings of..... ^ ` ............................................................ at......`i ��-.... C! r - .....� . North Andover, Mass. Fee H,(-�........Lic. No.e 7..... .M ............. PLUMBING INSPECTOR Check# V a � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY G MA DATE I Lq' f PERMIT# I� � JOBSiTE ADDRESS NER'S NAME E P OWNER ADDRESS _ TEL =FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: d RENOVATION:© REPLACEMENT:® PLANS SUBMITTED: YES® NOD( FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER i ._ -.J —i 1 i I ___..._.J ___.__j DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I _ 3 �..� .__f _...--- _i -_._-_-J ..-_.__J ..__-..-__E -__.___I _.______E __-_j ___.._ __1 LAVATORY ! ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET _— URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER.PIPING OTHER E7 _ I i i 6 -�- -- INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES A NO �! IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I LIABILITY INSURANCE POLICY 5i OTHER TYPE OF INDEMNITY U BOND DI OWNER'S INSURANCE WAIVER:I am aware that the licensee 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 ,I AGENT JEII I SIGNATURE OF OWNER OR AGENT.-11 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wjthjall Pertinen2ro ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. < G PLUMBER'S NAME Lu A-kC Ug l LICENSE# SIGNATURE MP2, JP 0 CORPORATION Flj# PARTNERSHIP d# I LLC COMPANY NAME .4g -jFr4T7!'K P-9 i S.-S ; ADDRESS S J,a s f— S77Z�L f I CITY _1 STATEF—Wme-Jj ZIP Old! TEL i3 FAX CELL �]EMAIL L ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE US ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PER IT ❑ ❑ Ito FEE: $ PERMIT# PLAN REVIEW NOT ZS f The Commonwealth of Massachusetts - Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organization/Individual): Address: 57 -J"4sscr City/State/Zip: C-_wTa KJ, Phone#: �0 7- 41 5 7S� 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 mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. 9. Building addition Y p ❑ g [No workers' comp.insurance 5. ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.UTflumbing repairs or additions workers' mmyse oIto-of insurance required.]t employees.[No workers' q ] 13.[J Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Q�� �'N2�S ���� P-4 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 theimposition 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. I do hereby certify under the pains an dMialties ofperjury that the information provided above is true and correct. - Si afore: Date: y T• / `� Phone#• (o f 7 —41 S� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License U. 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#: r .a 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 P � � 1 enti or an two or more . . g t3'� Y 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-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 em to ees other than the inmlibers or partners,are not require o carry wor ers 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 permittlicense applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)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,M.A.02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 Www-mass,govldia :COMMONWEALTH OF p.MASSACHUSETTS:. , P - � PLUNfBERS AND GASFITTEfS LICE . SED-AS-A.MASTER"PLUIVi fISSUES THE ABOVE LIC 6N: CARSQN J LU MARQ-6ES d Y.1 57 'JASSET ST. : P' I NEWTONNA 0245U 1055 t {{ I3557 fl5lalll4 . 19282 - .COMMJONWE- LTH OF,MASSACHUSETTS- s rk PLUMBERS. ,kND GASFITTERS. LICEP+ISED AS A JOUR NE'YWAN PLUMBS f ISSUES THE ABOVE LICENSE.TO 1 CARSQN . i LU MARQUES 57 JASSET ST �. NEWTON MA 02458 262.6,T 0•,181/14 19`2Ei2tl `;I I dover Town n .: NoA r ver, Mass� 1011 Amt." Alret U LiClARP OP 1=1RALTH F��tl/Kir�l7un � spptic svit€rn r. RM T THISCERTIFIES THAT e9l Nellenlneell l}lueeeefellAeleeliHele.ill el Ae , ' leek� rr lir�rr hos permission to Erect.............. .eeeel.l.ee bNlldlngon .Y1001...... a ("l�l a e� 111 /��Ap occupied �7pp , $woto be occupied as ..... i111_ ie 1�1�1C „ Cl 1the . leeeeetlee e . A.lellt��..4eUleee.AfEeeeelreteeeelllee.l..0 it n ever roe ocf onform to the terms of thq application provided that the person ncccptlnp thie permit eho , I y p Anal on file In this office, and Loth® provlslons of the Codes and Qtr-Daws relating to the Inspection,Alteration and roLUmnIr�CTINr►13cralc Construction of Buildings In the Town of North Andover, t VIOLATION of the Zonln�or Building Regulations V�icle this Permit, �}�rnl 1 � N P� PERMIT EXPIRES IN ►NT rL �riuCnLiN �rr 'rare ' ,to UNLESS CONSTRUCT S TS WrOw lel l!lleee.el:..111 llel..eeau a ee el.u.leee.eel loll.elilo$I l.eeeleel+eulA BUILDING INSPECTORFW �A�IIVn�C'r�rt Rough Irinnl Display In s Conspicuous Pince on the Premises —Do Not Remove F1110 00PARTMRNT No Lathing or Dry Wall To Be Done Ilrrent.+r Until Inspected and Approved by the Building Inspector) 5tront Not Date��E/I�/.............. ,QF TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 2,vi...............L......�.................................................................................... ............ has permission to perform ..../9....... -f..x e I-/..!r1 ..... /.... ..........7.. .... A...1- 14 wiring in the building of..... .............I....... ....... at 0...... North Andover,Mass. ..... .............. ......................................... Fee.J� .��.......Lic.No.-IW. ,.Z.(p .....:.,/,4........./ . ......... . . ELECTRICAL INSPECTOR Cheick# C� 1223.9 , YQP A Official Use Only Commonwealth of Massachusetts ( Z� Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [R BOARD (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: 3 Z/ ! City or Town of. NORTH ANDOVER To the In pector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) (1-0 b <4 01"P N 42 r S ` 6 to �A- K rk Owner or Tenant 'H e-tcl-Vl Vak-,� Telephone No. Owner's Address S LtI-R_ Is this permit in conjunction with a b 'lding permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building 3 kL- Utility Authorization No. - Existing Service Amps / its 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: Comp etion of thifollo ing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets ,e(D No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] IN o.o Emergency Lighting O g rnd. rnd. Battery Units No.of Receptacle Outlets /_S— No.of Oil Burners FIRE ALARMS I No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and c� Initiating Devices No.of Ranges No.of Air Cond. w Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: ""' " """ ""'' ''" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Key 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 Wires. Estimated Value of Electrical Work: 4,S® z' (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, cinder the pains and penalties ofperjury,that the information n zis application is true and complete. FIRM NAME: LIC.NO.: Licensee: u j X,l A SignatureL,�,�- LIC.NO.:77� ca (If applicablg,enter "exempt"in a license number line. � Bus.Tel.No.: 5-bg-?yL!Z-Q137 Address: GX, C a7{z) 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 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 A 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 V 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 M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPE TIO . Pass M Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Com a s: Inspectors Signature: Date: FINAL INSPECTION: Pass 1fl V Failed Re-Inspection Required($.) ❑ Inspectors Com s: L Inspectors Signature: D e: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com z - . The Commonwealth of Massachusetts Department of IndustriqlAccidiiuts Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: ) 2,5 City/State/Zip: k i � C. /L4 A-b 17Go Phone#: v — 7 oc--ol3 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 employees(fitll and/or part-time).* have hired the sub-contractors 2J9 I am a sole proprietor or partner- listed on the attached sheet.# Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]uiemployees.[No workers' q ] 13.EJ Other comp.insurance required.] *Aliy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 DIA for insurance coverage verification. I do Izereby certi der the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: l 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#: r 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 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,uested,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 permithicense 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 *ermit to burn leaves etc. said person is NOT e p ) p 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, `r please do not hesitate to give us a call. The Department's address,telephone and fax number: The GoMY40 wealth of Massachusetts Department of fadustriat Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 WW.Mass,govldia i i COMMONWEALTH OF MSSp►OIiUSETTS BP ISSUES THE FOLLOWING LiC�N5E AS A° REQ JbURiJEYMAhI.ELECTS I C!aN" jz 6o 3624,.. :: N AT 'i� .'914t "6. ►+ 486E o J Date....—...! �1. .. µOR7►� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACMUSEt /R r 1 Thiscertifies that .... ............... ... .... .................................................... has permission torform .................. ................. ........ . .. . ....................... wiring in the building of...ME:........ ...................................................... at...y ... .... . .....` .\.'J�''^�J..... ,No � Andover,Mass. Fee..�1............ Lic.No?T�� !�4�'...; .... ...... ...-................... _`�ELECTRiCALCTOR Check # 4749 Date....2:7... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. ..... ...... ............................................... nn .... has permission toirfor—m -?,... .. .. ..................... wiring in the building of... ...................................................... at...'�"A�.�..... .i5l .. .... ...0—................ .No Andover,Mass. Lic.N ........... ..................... ELECTRICAL PEC TOR Check # 4749 LonW"nwea[l/i 01741Aas.4aeltudeild Otlicial Use Only�7 p 2eparinw l a/_%.Servi'eee Permit No. Lf/4 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ` Rev. 11/991 icave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perrormed in accordance with the Massachusetts Electrical Code(h.IEC),527 ChIR I2 _.no (PLEASE PRINT LV INK OR TYPE ALL INFOIWA 'ION) Date: City or Town of: �o�1 A4 p�d, y To the Ltspector of fVires: By this application the undersigned gives notice his or her intention to perform the electr'cal work described below.Location(Street& Number) o� d✓ S' O!at/ /-P- Owner or Tenant Telephone No. Owner's Address Is this permit in cotrjunctioti with a building permit? Yes No Pq (Check Appropriate IIox). Purpose of Building Utility Authorixativn No. Existing Service Amps1'olts Overhead Q Und rd g ❑ No,of Meters . i New�crvice Anips ! Volts Overhead❑ Undgrd Q Ne.ofINIeters. Number of Feeders and Ampacity Location and.Nature of Proposed Electrical York: Conn letion orthe ollorvin table ntav be iiaived b the hr' `cctcr of;vires. No.of Recessed Fixtures No.of ceii;Susp.(Paddle)Fans °-° ota Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above No of Lighting Fixtures Swimming pool ❑ n- o.o mergency g itmg Arad. rid. Battery Units No.;Of Receptacle Outlets No.of Oil Burners FIRE AlAR,IIS i`lo.of Zones No.of Switches INC.of Gas Burners i o,o etection as Initiatln Devices No.of RangesNo.of Air Coad. Toortras No.of Alerting Devices No.or Waste Disposers eat Pump Ii unr er oro__ _ o.o c - onto ne Totals: Detection/Alertinp Devices . No.of Dislrixashers Space/Area Heating KW Local ❑ uric pa Connection Other No.of Dryers Heating Appliances KW ecuritystents: o.of Water No.ofyDevices or Equivalent. Heaters eaters XW °�° j °•° Data Wiring: Si iu Ballasts No.of.Devices or E uivalent No.Nydrolnassage Bathtubs No.of Motors Total HP Telecommunications ring: No.-or Devices or Euivaiene OTHER: ' Attach additional detail if desired,or as required by the Inspector of Mres. 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 e:dribited proof of same to the permit issuing office, CHECK ONE: INSURANCE ja BOND ❑ OTHER ❑ (Specify:) y -- 03 Estimated Value of E ctrical Work:* 0 P (When required by municipal policy.) (Expiration Date) Work to Start: TZ��} Inspections to be requested in accordance with MEC Rule 10,and upon completion. I ccriffy, tinder the pants.and penalties ofperjury,that the ittfortttadon on this application is trite and complete. FIRIII NAME: d /lo LIC.NO.:g sr/S Licensee: *An /9 • GR//a Signature. LIC.INO.:�,9 �—g—�� X7— $,/ q (!f applicable,enter "ercuent"in the license nrrsnber Gne.J Bus,Tel.No. � Address: .v• 6e re .y3�"� �t;:,cv t✓� Ci. . /`fA a���y alt.Tel.No.: OWNER'S INSURA�C>r tiYAIVER: I ant aware R t e Licensee does trot(rave the liability insurance coy ezage normally required by law. Ba my signature betvw,I hereby waive this requirement. I am Ute(check one)❑owner ❑owner's went. Owner/Agent Signature '1'elcpltone Nv. 1'isRdIIT FEE: $ j � � . TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'ss��Mus�t 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.9542—FAX Public Health Director E-MAIL: healthdept@townoffiortliandover.com WEBSITE:http://www.townofnorthandover.com April 11, 2005 To all Sharpeners Pond Road Residents: Please note that it has come to the attention of the Health Department that many residents are leaving their trash barrels and trash bags out at the curbside for days, or weeks at a time. .Empty trash barrels blowing about in the road are a safety hazard, and trash and debris along the roadway is a health hazard. Please be mindful of this, as the Health Department will conduct periodic inspections of the area to determine who is in violation, and fines will be issued if protocol is not followed. The Board of Health follows the State Sanitary Code regarding Human Habitation, 105.CMR.410, Section 1: 410.600 (A): Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight- fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent-proof material. Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B): Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight-fitting covers as required in 105 CMR 410.600(A), provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence in making its determination the Department shall consider, among other things, evidence of strewn garbage,torn garbage bags, or evidence of rodents. 410.602 (A) Land. The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other refuse. The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety, and well-being of the occupants of any dwelling or of the general public. (D) Common Areas. The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the passageway or right-of-way which abuts his property and which he or the occupants under his control have the right to use, or are in fact using, or which he owns. •1 Residents should know the following: • The Town has a mandatory paper and cardboard recycling ordinance that requires residents to separate these items from their household trash. Paper and cardboard are collected every other week on the same day as the household's normal trash. Residents can call the DPW at 978.685.0950 to get their recycling schedule. • Residents are responsible for picking up loose trash left at the curb after collection. Banned Items and Recycling Requirements: Please refer to the DPW website for a complete list of all the recycling requirements: http://www.northandoverrecycles.com. Please contact the Health Department if you have any additional questions. Thank you. Sincere an Y. Sawyer, RE HS / Public Health Director File Y ,,.:�.f"' �....� tip_, :.,7•.. .Z: .'Y-.r.. ., .y.. ...,_,h,�y�F - �-_ ._ -- �.,,,� Location No. �3 Date 401t I T; TOWN OF NORTH ANDOVER, Certificate of Occupancy $ r U +_ ; • Building/Frame Permit Fee $ Ui r ACHU < .� Foundation Per Fee $ . Y er It ee $ Sewer Connection Fee $ Water Connection Fee $ �* TOTAL $ 3. 4 Building Inspector Y . 7462 Div. Public-� Works PERMIT NO., APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 � r AP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK iPAGE ZOIJE SUB DIV. LOT NO. OCATION �I PURPOSE OF BUILDING e A J ,/ �l 4 J�WNER'S NAME,—y,_ I NO. OF STORIES c'Above SIZE Ota[ �y "Wb /� CJ OWNER'S ADDRESS q BASEMENT OR SLAB ARCHITECT'S NAME CJ SIZE OF FLOOR TIMBERS IST 2ND 3RD ILDER'S NAME P 1 SPAN —� (STANCE TO NEAREST BUILDING ('7�.. DIMENSIONS OF SILLS I STANCE FROM STREET G �,�t.�X [y`'1 c POSTS DISTANCE FROM LOT LINES SIDES ` f-'� T•_� AR 0 GIRDERS AREA OF LOT j�,l `'�/ P� FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ff �J SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO'TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE li INSTRUCTIONS 3 PROPERTY INFORMATION LD COST SEE BOTH SIDES - EST. BLDG. COS .Co PAGE t FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. / PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM PERMIT NO. /Z ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED B ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR T F LW BOARD OF HEALTH SIGNATURE OF OWN P, OR AUTHORIZED AGENT FEE �7 RTEL. 52 PLANNING BOARD PERMIT GRANTED C NTR.TEL.#6f ��(�s, is ONTR.LIC.# i Z. Zir :LELCTMIEN YILDING INSPECTOR a i BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _�OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL - UNFIN. 3 BASEMENT AREA FULL FIN. B M T AREA _ 114 1/2 V. FIN. ATTIC AREA _ N_O B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDWD _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE - 5 ROOF 10 PLUMBING GABLE I HIP BATH )3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) r FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK t SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd 11 NO HEATING FORM u - IAT RELEASE FORM - INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, . regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone �. ,YYI °� `:- ���9,�- LOCATION: Assessor' s Map Number Parcel Subdivision Log s% Street '1`ll� t��OX� �h� St. Number Use Only************************ REC NDATIONS OF TOWN AGENTS: —� Date Approved Consen�ation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved F od Inspecto-r-Health Date Rejected Date Approved 9� Septic Inspector-Health Date Rejected Comments Public Worts - sewer/water connections _ - driveway permit Fire Department Received by Building Inspector Date 7 j 1D act S ice* ! E e - ice-.. _�. ��_r._7!i.F��'�++�'_ �' y i, 1 �`•tf �" •" �' 1 41 13� 4' ' ,, -L-A- �C�f �1 C�� '/U � � v � �-t ��� �� /� / �I ARNIVAL . - � "NEW a Inch 50a o Wall Height dh- TSiMgnature of Quality" liillllll IIIIII�III II I t �I nee`. 1 4 6 f n d �3 tot t Family togetherness is a . . ° wholesome feeling . . . f f . There's no better place to share those "° special moments with your children AVAILABLE WALL COLORS: as they grow up than in the comfort of your own Esther Williams pool. It a pleasure to share the fun with family and friends. It's an activity center the whole family will enjoy for 10 It "Swimming is such a great family activity years to come. And, your Esther . ,* _ we spend more time together than ever. Williams pool comes with an amazing UL'a 60-year warranty. BLUE/WHITE TAN/WHITE FEATURES: ❑ All Aluminum Construction -C ARNIVAL eliminates rust forever ❑ Patented Interlocking Wall Sections make Esther Williams the strongest pool available ❑ Extruded Aluminum (/ o Anchor Plates and The Signature of Qu�liry" Extra Thick Tie Bars are stronger to keep your pool straighter Stainless Steel ❑ Patented Deluxe New, 22 Mil. Virgin New Pool Fencing In-Pool Ladder Liner with Beaded, 22 Mil. Virgin vinylmeets or exceeds Vinyl Liner resists mold, 20-YearWarranty most building codes mildew and bacterial fungi and standards ❑ 60 Year Warranty ❑ New, 50" Wall Height and larger pool sizes � � add more swimming bo area . . . for more fun and comfort � 3 OPTIONS: ❑ POOL FENCING o Top Quality, Durable, ..� Extruded Aluminum a Meets or exceeds := most Building Codes �o �� Swing-Up and Standards — Including a pN Entrance Ladder BOCA, NSPI, UBC, SBCC ^9.q, o Virtually Maintenance Free El PATIO DECKS `= ,,,.� ` Strong,Extruded Aluminum Buttresses o Extruded Aluminum Interlocked Panels 50" Wall Height Welded for maximum ' strength Thick, Interlocking New, Larger Coping o Virtually Maintenance Free Wall Sections with Duracron slip- • Comfortable, Color strengthen your pool resistant finish Co-ordinated Weather Resistant Carpeting o Includes Swing-Up OVERALL POOL SIZE SO. FEET MAXIMUM OPERATING GAL. Entrance Ladder and DIMENSIONS: CAPACITY (GAL.) Stainless Steel In- (Excluding Buttresses) 13' x 19' 198 6.,172 5,431 Pool Ladder 13' x 22' 235 7,325 6,446 o Available: Large Patio 1 8 558 End Deck or Side Deck ' �6' x 30'* 402 12,531 11,027 ❑ WALK DECK 19' x 34'— 524 16,334 14,373 o Spacious 18" wide (including coping) HEIGHT: 50" Wall Height o Durable Extruded Aluminum TOP RAIL: 7 Inches o Duracron Slip- Resistant Finish will Specifications Subject to Change not crack or chip _ MADE IN Ask Your Dealer About Special Prices on Deck and Fence Packages T 1892-39-D, FEATURES: ❑ All Aluminum Construction ARNIVAL eliminates rust forever ❑ Patented Interlocking Wall Sections make Esther Williams the p strongest pool available n o 0 0 ❑ Extruded Aluminum U Anchor Plates and "Th.Signature of Quality" Extra Thick Tie Bars are stronger to keep your pool straighter Stainless Steel ❑ Patented Deluxe New, 22 Mil. Virgin New Pool Fencing In-Pool Ladder Beaded, 22 Mil. Virgin Vinyl Liner with 20 Year Warranty meets or exceeds Vinyl Liner resists mold, most building codes mildew and bacterial fungi and standards r. ❑ 60 Year Warranty n Qg 4. ❑ New, 50" Wall Height 4 and larger pool sizes ,� � add more swimming area . . . for more fun and comfort OPTIONS: z ' ❑ POOL FENCING Top Quality, Durable, Extruded Aluminum o � Meets or exceeds most Building Codes " �� Swing-Up and Standards — Including '°a �; Entrance Ladder BOCA, NSPI, UBC, SBCC � - or Virtually Maintenance Free ❑ PATIO DECKS a - Strong,Extruded '' y, , Aluminum Buttresses o Extruded Aluminum c + ,^^- � - w•a� . Interlocked Panels 50" wall Height Welded for maximum strength New, Larger Coping g Thick, Interlocking • Virtually Maintenance Free Wall Sections with Duracron slip- strengthen your pool resistant finish o Comfortable, Color Co-ordinated Weather Resistant Carpeting o Includes Swing-Up OVERALL POOL SIZE SO. FEET MAXIMUM OPERATING GAL. Entrance Ladder and DIMENSIONS: CAPACITY (GAL.) Stainless Steel In- (Excluding Buttresses) 13' x 19' 198 6,172 5,431 Pool Ladder 13' x 22' 235 7,325 6,446 o Available: Large Patio 21P 9,725 8 558 End Deck or Side Deck h^ 6' x 30'' 402 12,531 11,027 El WALK DECK � 19' x 34'� 524 16,334 14,373 • Spacious 18" wide (including coping) HEIGHT 50" Wall Height a Durable Extruded Aluminum TOP RAIL: 7 Inches • Duracron Slip- Resistant Finish will Specifications Subject to Change not crack or chip MADE IN Ask Your Dealer About Special Prices on U �� Deck and Fence Packages T 1892-39-D, ARNIVAL -NEW 5Inch a OWall Height "The signature of Quality" 3 e rµ \► t(, '` a n Yt? GGA r�i A� r nd g Family togetherness is a wholesome feeling . . . Y . � There's no better place to share those " aY special moments with your children AVAILABLE WALL COLORS: as they grow up than in the comfort of your own Esther Williams pool. It w r t ` ' a pleasure to share the fun with family and friends. It's an activity center the whole family will enjoy for "Swimming is such a great family activity years to come. And, your Esther we spend more time together than ever. . ." Williams pool comes with an amazing 60-year warranty. BLUE/WHITE TAN/WHITE i Town of0 No. 298 - zc "NorthAndover, Mass., l�fl Is, ' L BOARD OF HEALTH Y PERMIT To BUILD Food/Kitchen f Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.., t, .. .., !1 .4/' ..... :.b.S ................................. '•' Foundation i has permission to erect.......,..t.Qd..�............... buildings on .. .. . ....5 . ."'..s.....t4!. .. ..... ( Rough t0 be occupied as a dd Chimney p 1.�r", ...3c�..... ....c� 1... .c�.... ....................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT11_�..1-)JJRE:; I °; U 71 U 17 } 1 ", ' Final UNLESS �,�.�.1 h�S ���:� ELECTRICAL INSPECTOR � Rough ....... ................. ................................. Service i BUI TOR Final Occi tImi'tCy to q) , BLtill.d�i1l�� GAS INSPECTORRou Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER -FINAL DRIVEWAY ENTRY PERMIT ' POOLS-SPAS-SUPPLIES POOLS 8 SPAS IN GROUND-ABOVE GROUND PATIO FURNITURE POOL SPECIALISTS Inc.POOL TABLES by Bemister s ' ASSORTED GAME TABLES / THREE LOCATIONS: 575 Lafayette Road, Rt. 1 57-61 So. Broadway Route 102 Hampton, NH 03842 Route 28-Salem, NH 03079 Hudson, NH 03051 929-4447 893-3273-898-9698-893-2562 889-1516 I /We, the owner(s) of the premises mentioned below hereby contract for work to be done according to specifications, terms and conditions described below. 'ell � f -(j _ ,�„ �7, Owner's Name Tel. Number ,�iZ2_(.6'f • °��— r�f— 1 I �. StateAddress c Details of Work _, • 42 _ j Owl . Deposit Material to cost $ payable as follows: $ On Excavation $ Pic'--up or I Delivery. This contract constitutes the entire understanding of the parties and no other agreement represents and/or warranties, collateral or otherwise shall be binding unless in writing and signed by both contracting parties. IN WITNESSWHE arties have hereunto signed their names this day of 9 . Accepted Signed /o/wNER BEMISTE Signed owNER Per: Signed REP VSENT vE 0 W N E R a' o By SCOtt . Pools y 88 West Emerson, Melrose, MA 02176 (617) 665-77110, Installation agreement between Pools by Scott herein called installer and �i;7 /���r herein called the customer of the real estate located at zgej for the installation of one swimming pool size/l.��1,Q base installation price purchased from consisting of the following: fence deck - walkway brackets etc In order to maintain the lowest possible installation price, the following conditions must be agreed upon. 1. The installer warrants the pool installation against defects in workmanship for swimming season(s). (Season ends Dec. 31.) y/ �.� 2. Installation does not include electrical work. n the customer. i at a location chose b m boxes and pool packaging are to remain at the pool site, Y 3. All empty p p � g 4. Installer is not responsible for removing sod, rocks, dirt, etc., remaining from the excavation or for damage to the grounds resulting from the normal use of equipment. 5. Customer is responsible to comply with any local zoning ordinances and to obtain any necessary permits and specifically assumes sole responsibility for the exact location of the pool. 6. Customer is to stake out pool site. 7. Customer is to make sure pool site is not located over any underground services, leaching fields, septic tanks, etc. Any damage done to the aforementioned will not be the responsibility of the installer. 8. There will be an additional charge if the pool base has to be moved more than twenty-five feet from the pool site or if other than normal conditions exist. 9. Landscaping is not included in the installation, nor is the installer responsible for any alterations to the landscape. 10. Customer is to supply hoses, water to fill the pool, and accessibility to the pool site for any equipment that is needed. 11. All efforts are made to remove wrinkles from the liner. However, due to the prefab nature of aboveground pools, weather conditions and other factors, WE DO NOT GUARANTEE A WRINKLE-FREE LINER. 12. The installer is not responsible for any manufacturer's defects including the liner and any results of that defect such as loss of water. 13. Decks, fences, and accessories are not included in the normal base installation price. 14. For your safety, this is a nondiving pool. Customer assumes full responsibility to make all users aware of this fact, and assumes any liability which may result from misuse of this pool. He also agrees to make sure signs indicating NO DIVING are affixed in a conspicuous place and remain in good condition. 15. The installer is not responsible or liable for any damage to the pool or for a washout of the cove inside the pool due to poor water drainage surrounding the pool area caused by rain, flood, acts of God or any types of storm, emptying the pool of water or failure to winterize the pool. 16. The installer will not guarantee an appropriate fit between, an existing deck and a new pool. 17. The pool base may arrive without notice. Please leave driveway clear if no one is to be at home. •18. Dates of installation are subject to change at the discretion of the installer due to weather conditions or installation delays. 19. There will be an additional charge of$25.00 if your bank returns your check unpaid. " 20. The installer is not responsible for missing pool parts. Definition of a normal installation is as follows: Pool site within 8" of level, soil condition normal, no large rocks, tree stumps, etc. If heavy equipment is needed, there will be an additional charge. If due to ground conditions the machine is unable to bring the pool site to grade customer is to pay for services rendered and installer will discuss further options with customer. The owner agrees with Pools by Scot in consideration of the yerformance of the above specifications to pay the contractor the total sum of$ % , of which $ has been paid this date and $ CASH OR CERTIFIED BANK CHECK is to be paid upon completion. This agreement constitutes the entire agreement between the parties, and no other representations, agree- ments, or commitments are binding upon the parties unless specified in writing in this contract. In witness whereof, we hereunto set our hands and seals. COMMENTS: DTE AUTHORIZED AGENT- DACu_ MER li`'