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Home My WebLink AboutMiscellaneous - 415 WAVERLY ROAD 4/30/2018 (2)N r � O � � iv � I b m I N � mG D 3� O O F / / -i Date .... e� & �-' ...................... TOWN OF NORTH ANDOVER 00, PERMIT FOR WIRING C--, 'Z� a&-, -e- 'Mis certifies that .. i� ....................... C-� .......... I .................. ................................ has permission to perf orm ...... .................................................................. wiring in the building of ............................................ at ..-17�7 ..... A� ......... . North Andover, Mass. Fe6�. 0r.... Lic. No. .............. Check # 8291 1 n -CN- Commonwealth of Massachusetts Official Use Only WIMFPermit No. ?CP91 Department of Fire Services Occupancy and Fee Checked �S 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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 — I I, 0,i - City DCity or Town of: NORTH ANDOVER - To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) '`j I S WArVQ,-I 2 Owner or Tenant Z'C r y� j /,1 Telephone No. 12 8 -V aW Owner's Address 5 -c- Is this permit in conjunction with a building permit? Yes ❑ No M (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServicrL e Amps l ap / �.yp Volts Overhead � Undgrd ❑ No. of Meters c New Service Ip Amps / 4 Volts Overhead P"' Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Ins ector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In-0-orrmergency Lighting WBattery rnd. grnd. Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW "....""".......... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances Kms, 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 E uivalent OTHER: ,,&,/ Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1, Q)Q, pe) (When required by municipal policy.) Work to Start: Y — _ 0,6 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under tlKpains and penalties of perjury, that the inform on on this application is true and complete. FIRM NAME: �, 'rte L ec e i % 6- / �z LIC. NO.: q66,�- Licensee: Idl j (,byA �,/�, 1 4 e tl 1 �� Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) ' Bus. Tel. No.•603L- Address: 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: Pc2—Q4 on Z It Phone C)3_ S'G (�z 9 s Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I ,employees (full and/or part-time).* have hired the sub -contractors 2. 91 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] 10 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.0 Other '�,{r<Vi' 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. _ nn Insurance Company Name: f �fie�il/ TAI SU6`/it✓I Lt� Policy # or Self -ins. Lic. #: Q��- Ll �- Ci 3 G Expiration Date: �2— 10- Job Site Address: '4j /,s7- 141A'V e -Ay ll�� City/State/Zip:_ %. Ank / -r, 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 a a against the violator. Be vi h p to $ 250.00 da a y g advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby ce ify �ndefthe ains dpenalties ofperjury that the information provided above is true and correct. Sianature: Dnte- )- t /" % C /3 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 #: fl \( March 27, 2006 � u Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 J.J. Cammarata 437 Salem Street North Andover, MA 01845 Re: House Demolition — 415 Salem Street Scheduled Date: March 31, 2006 Mr. Cammarata; I recently purchased the property at 415 Salem Street, North Andover and I will be demolishing the existing house and deck on the property on Friday March 31, 2006. If you have any questions or concerns please feel free to call me at 978-352-7871 (H) or 781-389-8604 (cell). Very Trull V Xa;,s llivan Cc: North Andover Building Department March 27, 2006 William Sullivan 405 Salem Street North Andover, MA 01845 Re: House Demolition — 415 Salem Street Scheduled Date: March 31, 2006 Mr. Sullivan; Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 I recently purchased the property at 415 Salem Street, North Andover and I will be demolishing the existing house and deck on the property on Friday March 31, 2006. If you have any questions or concerns please feel free to call me at 978-352-7871 (H) or 781-389-8604 (cell). Very Tr J ck Su] Cc: North Andover Building Department March 27, 2006 William Macleish 412 Salem Street North Andover, MA 01845 Re: House Demolition — 415 Salem Street Scheduled Date: March 31, 2006 Mr. Macleish; ®L Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 I recently purchased the property at 415 Salem Street, North Andover and I will be demolishing the existing house and deck on the property on Friday March 31, 2006. If you have any questions or concerns please feel free to call me at 978-352-7871 (H) or 781-389-8604 (cell). Very T. Cc: North Andover Building Department March 27, 2006 Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 North Andover Building Department 400 Osgood Street North Andover, MA 01845 Re: House Demolition — 415 Salem Street Scheduled Date: March 31, 2006 North Andover Building Department; This letter is prepared as an affidavit that I contacted the immediate abuttors to 415 Salem Street on the demolition date referenced above. I mailed the letters on 3/27/06 and have attached copies of the letter for your files. If you have any questions or concerns please feel free to call me at 978-352-7871 (H) or 781-389-8604 (cell). Very Truly Yours, Jack Sullivan