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HomeMy WebLinkAboutMiscellaneous - 439 WAVERLY ROAD 4/30/2018(, X1.5 Date ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that..W, ( C,�n" I L V, -&A rt� .................... ....................................... ..................................... has permission to perform 00,c�>e— VV—PA -r, k VzM 0 i ..... ....... ............... ..... .................. I ... ....................... wiring in the building of ............ ...... ............................. :7!�� .................................................. at .... 4 .......... . .............................. orth Andover, Mass Fee .... Lic. No .......................... . ................. ................. ............... .. . ...... I Check # 21ZI- hLECTRICZ "I&S�P�EWT�O�R� Commonwealth of Massachusetts Ojj mciaUse r , Permit No. 1 �rl � vsee�" e Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAJLVORK All work to be performed in accordance with the Massachusetts Electrical Code ), 527 C 00 (PLEASE PRINT IN INK OR TYPE ALL INFORMAT1011) Date: City or Town of. NORTH ANDOVER To the Insp ctor f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant M11, Telephone No. Owner's Address , " a - Is this permit in conjunction with a building permit? Yesa' No ❑ (Check Appropriate Boa) Purpose of Building �, y1 G %,y., Utility Authorization No. Existing Service T / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: l�k t�i v A- g . Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- E] rnd. rnd. No. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Toons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons .......... No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑unicipal F1Other Connection No. of Dryers Heating Appliances KW SecuritySystems:* 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 elecommumcations 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: ,J� (When required by municipal policy.) Work to Start:SInspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE V GE• 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 covera a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the p 'ns and penalties of perjury, that the information on this application is true and complete- FIRMNAME: LIC. NO.: / 2 9,2 0 d Licensee: �FW ivY7�TKd"f. _SignatureLIC. NO.: Z�'[�2� (Ifapplicab e, enter "exem rn the lice- a number ' .) Bus. Tel. No.; 312 Address: N a Alt. Tel. No.: *Per M.G.L c. 147, S. 57-61, ecurity 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: $ -� 3 V r F L.- �ti ems,. .1Ize Comrrtonweafth of tt2"assaghnsefts - �epa��rner�tof�'n�'u��rccl.�ccie%n�� Office offavestigaflons 600 Washington Street Boston., MA 02111 www rnassgovldia wQrl ere ' CoxnpensatonInsurauce Affidavit: BuRder,-ICoxikaetors/Elect cxanql*)bex,o Name (Businessforganizaiionll'n&idual): Cityl&aieMp: r i .Are you an. employer? C&A the appropriate box: Type of project (required): I. �kl'am a employer with 4. ❑ I am a general contractor and I 6. New c6ustruction F employees (fall andloxpax- time) * have hirediho sub -contractors 2. ❑ I am a sole proprietor or partner listed on the attached sheet 7. Remodeling Ship and 'lave, no.employees These sab-contractors have S. [l Demolition woxlting forme in any capacity. workers' comp. insurance. 9. Building addition [NO worlfers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electricalxepairs or additions required.] officers have exercised. their am a homeowner doing all work right of exemption per MOL 11.Ej Plumbingxepairs or additions myself PTowoxkers' comp. c.152, §1(4), andwehaveno 12.x] Roofrepans insurancere ed. � employees. (No workers' � 13.] Other comp. insurance required.] Any applicant that checks box#I must also fill outtheseetion beI6wshowingtheirworkers' compensationpolicy information. Someowners who submittth dgdavit indicatingthey Aie doing allworgand then hire outside contractors must submit a nevi affidavit indicating suoh. xContraotors that cheokthis box must attached m additional sheet showingthe name of the sub -contractors and their -workers' camp, policy information. X am an employer that lqp oviding worIfers' compensation insurance for my ewTfoyees Be101P is Aepoliey an4joh site information. Insurance CompanyName;. Policy # or Sell ins. UG. ff: / T(nl G y ��2 l EXpiragou Date: Tob Site .Address: CitylS tate/gip: Attach acopy afthe workers' compensation olley declaration page (showing.flae Volley umber and ex, pirattonL date) Frillure to secure coverage as xegwodimdex Section 25.A ofM(3L o.152 can lead to the imposition of eriminalpenaities of a fine up to $1,500.00 and/or one-year imprisonment, as well -as civil, penalties in the form of a STOP WORD ORDER. and a tine ofupto$250.00aday against the M. Dlator- Baadvised that acopyofthis statementmaybeforwarded tothe Office o£ Xnyestigations of the DIA for insurance coverage verification. X do liereby eerg_fy that the in, formation provilecl aboye is true and correct, official use oply..Do not write in this area, to be completed by clay or taiga official. City or Town: Permit/License M fssuing.Authority (circle one): 1. Board of Health. 2. BuildinglDepartment 3. GfyfTown Clerk 4. Electrical Inspector S. Plumbing Inspector f. Other - - - Information and Instruction Massachusetts General saws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an ernqvloyee is defined as "...every poison k the service of anotherunderany contract ofhire,• express orh plied, oral orwxiiien?, An ewfoydis defined as "an zudividual, partnership, association, corporation or other legal entity, or anyiwo ormore of the Fore` oin engaged in a joint ente rise and includin the legal re resentatives ofa:deceased em. to ex .ox the g,� �g J � 9 g g p � y� receiver orinzstee of an individual, partnership, association or other• legal entity, employing employees, :66ovex tha owner of a dwelling house having notmore than, three apartments and who resides thero4 or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or onihe grounds oxbuilding appitttenanttheteto shailno `becausl; of uC7i emplbyih.entbe doomed to be an employer., MOL chapter 152, §25C(6) also states that "every state or local licensing agencq s7za yzthlzo`Id e issuance ox'' renewal of a Veense or;permit to operate a business or to construct buildings in the corhmonwealth for arty applicant who has ndt pro duced-aceeptable, evidence of compliance with the insurauce7cdvcx�g6 tog 1, Additionally, MGL chapter 152, §-25C(7) states "Neither the commonwealth nor any outs political subdivisions shall enter into any contractfor the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to th6 contracting authority." Applicants - Please f11 out the workers' compensation affidavit completely, by checking to boxes that apply to your situation and, if A6cessary, supply sub -contractors) name(s), address(es) andphonenumber(s) alongwith their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liah tyPartnerships (LLP)with no employees other than the members oxpartnors, arenotrequiredto carryworkers' compensatiflnhmmu mce. If an LLC orLLP doeshave employees,apolncyisrequired. Be advised thattbisaffidavit maybe. submitted tothe, Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date theaffidavit. The affidavit should be retam.ed to the city or town that the application for the permit or license is being regao ted, xtot the Department of industrial Accidents. Shouldyou have any questions regarding the law or if you are xequired to obtain, a *oxkers' componsationpoRGY, please call the Department at the number listed below.Self-lv xedcompaniesshouldentertheir self insurance Incense number on the appropriate line. City or Towu 00cials Pleasebesur ethat the a ixdavitiscompleteandprintedlegibly. TheDepartmenthaspxovidedabs aceattliehofLom ofthe ai�davitforyouto flu out in the event the Office of4vestigationshastd cdntactyou regarding t o applicant. Please be -sure to fll inthe pexmit/11cense number whichwM be used aS a refexe tce 9rumber. In. addition, 4an applicant t iatrhust submitmu*le pexml ylicense applications in any givenyear, need only submit one af�davii indicating current PORGY information (ifnecessw) and under "Job Site Address" the applicant shouldwrite "ail locations or town):'A copyoliheaf�davitihat$asbeen.of�ciallystampedormarkedbythecityortownmaybaprovidedtoihe appincant as prboffhat a valid affidaeb's on file fox fiziirre p exmits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture Qi e, a dog license orpermit to burn leaves eta) said p erson is NOT required to complete this affidavit. The Office of lnmvestigatfons would like to thank you in advance for your cooperation and should you have any questions, please do not hesitaie to give us a call. The Department's address, telephone ahA faxnumber: T`hQCQ QjUWtajtjtOfMas�a��y�P�t� - Ofte o�'TinV"Rg Vo.�,% 694a g j. Street BWon, 02111 Tei, 617n7-2,'�-4900 e#406 Q- x- 87-7,;MSS.F9 Devised 526-050�y4 • �.z�ta�,gQv�c�a -4 IV 1,RVCHARD J DRINKW 1 '5 SPR IN' w C I R F MA§'§A-*il N--=T-re CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 048(7/28/2006) Date: De mber 12, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 439 Waverly Rd MAY BE OCCUPIED ASI_ Condo Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: _ St__ ea6en;Smolack 762 Dale Street North Andover MA 01845 Building Inspector APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit #- O VT ADDRESSILOCATION OF PROPERTY:- Y -I G U Map 2 :L Parcel Lot Number SUBDIVISION _4i�c'. - DATE REQUESTED FILED/READY FOR INSPECTION - Zf - 07 CLOSING DATE ON PROPERTY: _/ - 0 ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address 76404 CONSERVATION PLANNING DPW - WATER METER • .0ik, ie V SEWER/WATER CONNECTIONFV NOT DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW Signature File: Application for OC form revised Jan 2007 M M w �I 1 cal a o` H o � w °b a Icz, w C � O N C . o 0 C3 :,a= CLC O A �i m C ;Z O W aG U) .0 1 ro m Ea m c s: m o U o W o w o w ' k.cn cn cE cal z 0 w w a V V V 2 Iff ir Re 9 C 0 CD O CD L O Z CD C. O CO) G O CM CO)CD O CO) CD m m CD G`. 4" = O A O O C O cc o a FL- cm< CID C Z ai O Ce V ca C cv — C� •s C c CO) W LUN U) W 19 W cn ,1 Sac c� O C � O N C . o 0 C3 :,a= CLC O A m C ;Z O O � m Ea m c s: m 3�a tom S S o WE E aE E o y m 3 C.,tj cp m t �• y ca c c y ev oo+ OW m lQ -�aC� y m ; m .� t = O c Q! �p,C.0 p m CO3 C3® :� hF.Z o w C CC C Q y O C •O COD c aa= m W O �' C +L-• ..� .Ca CL 'o cli ,.o' Z C.3 d o �. y m� O� W� = O S � = 4.06*— z 0 w w a V V V 2 Iff ir Re 9 C 0 CD O CD L O Z CD C. O CO) G O CM CO)CD O CO) CD m m CD G`. 4" = O A O O C O cc o a FL- cm< CID C Z ai O Ce V ca C cv — C� •s C c CO) W LUN U) W 19 W cn ,1 DateYA /<'A .. . RT" TOWN bF NORTH ANDOVER PERMIT FOR PLUMBING This ce.rtifies that .... ......................... has permission to perform .... A- . ............ plumbing in the buildings of ..... Dl!- ................ at .... Lt. ).'57 .. L. . pt .(./ ... / North Andover, Mass. Fee. Yr.? Lic. No.. //. j :'1Y. / .... q�. . . PL BING INSPECTOR Check.1 31-,� � - 34 s-5 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location S/ e "e K (t�j_ f� Owners Name C Type of Occupancy / J�CicJ�r/� Date_ © t Permit #___ _20 Amount �(? Plans Submitted Yes 0 No 0 I (Print or type) n Check one: Installing Company Name ��,,� >1' (,� �L Certificate []Corp. �� nn Corp. Address o2 UYUCdW Jet /U e— L-0-1-6 -C.) b3 Partner. nusuiess 'i e ep one 1y.2- Firm/Co. ;Name of Licensed Plumber: 1j JAW jryj q yV 4 Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate ox: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does nothave:.any one of the above three insurance Signature 1111 Owner Agent ❑ I I hereby certify that all Of the details and information 1 have submitted (or entered) in above application :ml, true and accurate tothe hestof my knowledge ;yid that all plumbing work and ' stall perfornied under Permit Issued for this ;application will he in compliance with all pertinent provision; of the 1 ,"- • usctts State Plu ng Code. and ( ter 142 f the General Laws. By. ,.)I� .L UCC (; Wf:nSLi aim .•r _. Title , City/Town APPROVED (OFFICE UH ONLY T., P�C Of P'Utnhing License � 6.77 0o dd tcc nse i urn er Master 1/ Journeyman i • r V i -.....-.-�. 11 " �um .. �. 1 .R] .��. " " •...---.MMIN -..I J�CicJ�r/� Date_ © t Permit #___ _20 Amount �(? Plans Submitted Yes 0 No 0 I (Print or type) n Check one: Installing Company Name ��,,� >1' (,� �L Certificate []Corp. �� nn Corp. Address o2 UYUCdW Jet /U e— L-0-1-6 -C.) b3 Partner. nusuiess 'i e ep one 1y.2- Firm/Co. ;Name of Licensed Plumber: 1j JAW jryj q yV 4 Insurance Coverage: Indicate the t e of insurance coverage by checking the appropriate ox: Liability insurance policy Other type of indemnity Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does nothave:.any one of the above three insurance Signature 1111 Owner Agent ❑ I I hereby certify that all Of the details and information 1 have submitted (or entered) in above application :ml, true and accurate tothe hestof my knowledge ;yid that all plumbing work and ' stall perfornied under Permit Issued for this ;application will he in compliance with all pertinent provision; of the 1 ,"- • usctts State Plu ng Code. and ( ter 142 f the General Laws. By. ,.)I� .L UCC (; Wf:nSLi aim .•r _. Title , City/Town APPROVED (OFFICE UH ONLY T., P�C Of P'Utnhing License � 6.77 0o dd tcc nse i urn er Master 1/ Journeyman Date. .......... TOWN OF NORTH ANDOVER Z. PERMIT FOR GAS INSTALLATION e4� This certifies that ............................ has permission for gas installation . . A 3-:'� . (4 �� ......... in the buildings of ... � Z /..I. .4� ........................ at .... L-/. t.� ........ North Andover, Mass. Fee. N� . Lic. No. SINSPECTOR Check# 5679 1VIASSACHUSEITS UNIFORM APPUCATON FOR PERNUT TO DO GAS FITTING (Type or print) _ Q Date NORTH ANDOVER, MASSACHUSETTS Building Locations ../ Owner's Name New 13oo Renovation ❑ Replacement ❑ ° Permit # Amount $ QO Plans Submitted ❑ (Print or typ jj Name � p L Address L j'.0 G .5 GO Check one: Certificate Installing Company Corp. Partner. I. Firm/Co. Name of Licensed Plumber or Gas Fitter e �d Wil,¢ -, Vo INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No If you have checked Vis, please i4&cate the type coverage by checking theappropriate box. - Liability insurance policyUT Other type of indemnity Bond 13 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: Signature of Owner or Owner's Agent Owner n Agent n hereby certify that all of the details and information I have submitted (or entered) in above application`irertrue and accurate to the -- - "...,.... ...y nuv vv wut.., uuu LuuL cul t11u111Ul11g WUfK ana compliance with all pertinent provisions of the MasstS tsy: Title City/Town JAPPROVED (OFFICE USE ONLY) ions performed under Permit Issued for this application will be in State Gay9ode and CJx�pter 142_,4 the Geaeral Laws. 00, nature of Licensed Plumber Or Ga Fitter Ea/oPlumber // -5- Vp 1-3 Gas Fitter'license NumbEr ®Aster ® Journeyman Ww � C7 a O Z O Z z a C7 W d w yp W ° C) F z W OG w Y tU Cw7F z > F+ C zd 7 xrA ��C,aj tWC�4 E a C 3 O O W a C W F SUB -BASEM ENT w A C7 a U C4 > A a F C BASEMENT 1ST. FLOOR 2 N D. F L O O R 3RD. FLOOR 4T 1I. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. F L O O R 8TH. FLOOR (Print or typ jj Name � p L Address L j'.0 G .5 GO Check one: Certificate Installing Company Corp. Partner. I. Firm/Co. Name of Licensed Plumber or Gas Fitter e �d Wil,¢ -, Vo INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13 No If you have checked Vis, please i4&cate the type coverage by checking theappropriate box. - Liability insurance policyUT Other type of indemnity Bond 13 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: Signature of Owner or Owner's Agent Owner n Agent n hereby certify that all of the details and information I have submitted (or entered) in above application`irertrue and accurate to the -- - "...,.... ...y nuv vv wut.., uuu LuuL cul t11u111Ul11g WUfK ana compliance with all pertinent provisions of the MasstS tsy: Title City/Town JAPPROVED (OFFICE USE ONLY) ions performed under Permit Issued for this application will be in State Gay9ode and CJx�pter 142_,4 the Geaeral Laws. 00, nature of Licensed Plumber Or Ga Fitter Ea/oPlumber // -5- Vp 1-3 Gas Fitter'license NumbEr ®Aster ® Journeyman