The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 45 CHESTNUT COURT 4/30/2018 45 CHESTNUT COURT J 2101060 C-0055-0000.0 r i i I r Date.. ..��. .�� ............... TOWN OF NORTH ANDOVER o * ; PERMIT FOR WIRING s`SACHU This certifies that ...:.... ................... .........................L W m rt7 s has permission to perform ....... �� iv,,,`��Yj �t wiring in the building of e �'................................................................................... at ....�� It�PST I!� orth Andover, ass. ......................................... Fee... .. ........Lic.Nol?....�� '/ OCTAL INSPPOR Check# -� The Commonwealth of Massachusetts Office Use Only Department of Fire Services Permit# 1,2-441 BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked Rev.1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: June 11,2014 City or Town of No.Andover,MA 01845-5319 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) 45 Chestnut Court Owner or Tenant Noele Lee Tel. No. 617-325-3947 p� Owner's Address Some Is this permit in conjunction with a building permit: Yes FX No = (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Undgrd No.of Meters New Service Amps Volts Overhead Undgrd No.of Meters Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work Detached Garage with Work Out Room Completion of the following table may be waived by the Inspector of Wires. No.of Lighting Outlets No.of Hot Tubs No.of Transformers No.of Lighting Fixtures 16 Swimming Pool Generators No.of Receptacle Outlets 14 No.of Oil Burners No.of Emergency Lighting Battery Units �. No.of Switches 7 No.of Gas Burners FIRE ALARMS #of Zones z No.of Ranges No.of Air Cond. Tons No.of Detection 4 No.of Disposals No.of Heat Pumps kw No.of Alerting No.of Dishwashers Space/Area Heating kw No.of SelfContained No.of Dryers Heating Devices kw Local 1 lunicipal F—Other No.of Water Heaters No.of Signs Data Devices No.of Hydro Massage Tubs No.of Motors Telephone Devices Other: (1)60 amp sub panel Attach additional detail if desired,or as required by the Inspector of wires. Estimated Value of Electrical Work: (When required by municipal policy.) Wort to start: June 11,2014 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 the exhibited proof of the same to the permit issuing office. CHECK ONE: INSURANCE I ^ BOND OTHER F(specify:) I certify,under the pains and penalties of perjury,that the information on this application is true&complete. FIRM NAME Dumais Electric LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E (If applicable, enter"exempt"in the license number line.) Address 8 NewportStreet Bus.Tel. No. 978-683-9438 Methuen,MA 01844 Alt.Tel No. 978-685-4553 * 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 insurance coverage normally required by law. By my signature below, I herby waive this requirement. I am the(check one) owner )wner's agent Owner/Agent Signature Telephone No. PERMIT FEE: �� oAc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 y www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): Dumais Electric Inc. Address: 8 Newport Street City/State/Zip: Methuen,MA 01844 Phone #: 978-683-9438 Are you an employer?Check the appropriate box: Type of project(required): 1.[3 I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I 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. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.Q Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[1 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins. Lic.#: IEUB-7C83307-8-14 Expiration Date: 2/2/15 Job Site Address: 45 Chestnut Ct City/State/Zip: N Andover MA 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. /� ti Signature: Q• Date: Phone#: 978-683-9438 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#: Information and Instructions J 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia Please visit our web site at http://www.mass.gov/dpi/boards/EL DUMAIS ELECTRIC INC MARK A DUMAIS (EL) 8 NEWPORT ST METHUEN MA 01844-3425 Fold,Then Detach Along All Perforations _. COMMONWEALTH OF MASSACHUSETTS BOARD'OE EL1 tM C I ANS L SSUES THE FOLLOWING L I',tt E AS A REG I STE`R1rD MASTER .ELECTRI C IAN 1¢ DUMA l- ELECTRIC (NC ( �? MARK A DUMAIS ' + N 8 NEWPOf�T <S.r. �' : , f W IETHUNMA o1844 3425 12170 .A 07/31/x6. �73o6 Please visit our web site at http://www.mass.gov/dpi/boards/EL MARK A DUMAIS (EL) 8 NEWPORT ST METHUEN MA 01844-3425 Fold,Then Detach Along All Perforations ,COMMONWEALTH OF MASSI�CHUSETT SOA O DJF ELECTRIC'1ANS ISSUES THE FOLLOWINCa L-1 CENSE AS''A RCG U0URN EYMAN .ELECTR VCIA i �� z "MARK.-A DUMAIS Z : x. �. 8 NEWPdki ST % W M. THbEN MA 01844 3425F 27307 266654 . Date.. ��.:.��.. .. . HORT1y o� TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION . -off r SSACHUSE Thls certifies that . . . .��.. ��• • _ -.�..?1 has permission for gas installation . ... in the buildings of . . . ,� .' ?U• „ • • • at . A. . .....:?�:. .. . . ... .. " North Andover, Mass. Fee. .. . . .G . Lic. . . .;` f �. . . . . . . . . . . . . GAS 41 S6ECTOR Check# r• r v MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date CO/-121d S� 1 NORTH ANDOVER,MASSACHUSETTS Building Locations C Permit# r�f/ Amount$ Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted D U o0a W F F 1 O O a O 0 O W04 C7 F O � V a F 3 AOU. a Q 906. 1 O V SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR or type) �1 C�/��G�,� /��- Cilh c Corp. Certificate Installing Company Name Address S� /,7Jf- f -2Yom- Li Partner. Business Telephone Q C� Zo Q R'27✓r ❑'Firm/Co. Name of Licensed Plumber or Gas Fitter 0 J b e7 '0 111 lt�l � INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ff� No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Ea` Other type of indemnity ❑ Bond ❑ 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 ❑ Agent ❑ t hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuset tat Gas Co nd Cha r 142 of the General Laws. Signature of Licensed Plumber Or Gas Fitter By: 3 b Title Plumber City/Town ❑ Gas Fitter License Number �LVlaster PROVED(OFFICE USE ONLY) ❑ Journeyman 1 t' ...... Date.......L.D .`�J..�.. E �aORTM 1 "�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ;,SS^CMUSEt 1 This certifies that .............1....f..�..�............................................................ has permission toperform .......�t c G� • ( � s j i �...4...t. ...... wiring in the building of...............C �.d . )................................................. at.....`# ...................... .North Andover,Mass. Fee. - ym.. Lic.No. ��Z -�..�: / ...... ELECTRICAL INSPECTf6R ` Check # 1314 ��Z (// 9Ui, << (f .monwealM of)Wamac4uJaffa Official Use Only Permit N - 2partment o�.}ire �erviceS o. — Occupancy and Fee Checked _ r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code.(MEC/,�� - 7 Club: 12.00 (PLEASE PRINT IN INK OR TYP�ALL IJNVFOR!>>L47'I0N) Date: �/,2 City or Town of: Qr ,* Adewl-- To the Inspector of Wires.' By this application the undersigned gives notice of his or her intent to per/form the electrical work described below. Location (Street & Number) /�Jr e/, A�.4 G'L Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Autbori7ptiar; No Existing Service Amps _ / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of 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 Ge aerators KVA No. of Luminaires SwimmingPool Above [jIn- o.o Lmergency Lighting b arnd. grnd. — Battery Units INo.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. of Detection a.id _ Initiating Devices No.of Ranges No. of Air Cond. Total No. of Alerting Devices _ b Tons b Heat Pump Number J.To.q.s J.KW No. of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local Municipal Other onne 'on No. of Dryers Heating Appliances KW ��r t Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Rall c c _ rr�_. r� 2.,t Sens a t No.v'� ucVtCC3 or f. Cil:'a...�,� ' No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: g -7 .'t G!r7 Attach additional detail if desired, or as required by the Inspector of Wire 5 Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 0-!-.-�R Inspections to be requested in accordance with iv1EC 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 the pains rndpenalties perjury,that the i ormation on this application is true and complete. FIRM NAME:_ �� tht LIC.NO.:_�SC Licensee: G- Signature <,��_==�� LIC. NO.:"Llzj o U y (Ifapplicable, enter "exempt"rh the ense number line. Bus.Tel. No.'s S�oKJ Address: //7 'T-rn L) 1/5 , A-M Q.3-0 Sl2 Alt.Tel.No.: *Per NI.G.L. c. 147, s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. SS CC. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my si�,nature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's sent. Owner/Agent Signature ._ Telephone No. PER1i'IIT FEE: R _J (2 -0 Dep -r[ment of Public Safety One Ashburton Place, Rm 1301 ,oston, Ma 02108-1618 License: CERTir-ICAT-E OF CLEARANCE Number: SS CC 00197; Expires: 10/09/2009 Restricted To: 00 KENNY WONG 18 CLINI-ON DR _ MOLLIS, N11 030,19 ` Tr, no: 139.0 t-• Keep Iop for receipt and chan0o of od � ^•� ^^rrr' "-- 1.1 Ih.: ors-cel n sorLorrol rco+vo COf�'t_fJ�Cf I'dd•r.ALTH OF MASS*ACHUSET' ^ ✓�rC (fin nr nrn rrru�n l�� n�,i�lrrdlh t•�uJC�� .. . S \ UEPARTMENT OF PUULIC SAFETY �'•il c; CERTIFICATE OF CLEARANCE �. Number: 5S CC 00197 Expires: 10/09/2009 Tr. no: 49.0 5-1-1eonse: AOT SECURITY KENNY WONG 10 CLINTON OR t, MOLLIS, NH 03049 DIG SAFE: COIL CENTER: (000) 344-7233 Commissioner i •'1; ski C' GUM MAMCAN INSURANCE COMPANIES® PERSONAL LINES DIVISION August 30, 1991 DAY HILL CORPORATE CENTER 100 NORTHFIELD DRIVE WINDSOR,CONNECTICUT 06095 203/683-4700 MAILING ADDRESS: P.O. BOX 1079 HARTFORD,CONNECTICUT 06143-1079 NOTICE OF LOSS TO BUILDING UNDER MASS. GEN. LAWS CH. 139 SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen Town of N. Andover Town of N. Andover N. Andover, Mass. 01845 N. Andover, Mass. 01845 RE: Insureds)/Property Owner(s) : Richard & Muriel Picard Property Address: N. Andover, Mass. 01845 Our Claim Number: 603 511352 Date of Loss: August 19, 1991 Dear Sirs: A claim has been made involving loss, damage or destruction to a building or other structure located at the above property address, which may either amount to $1, 000. 00 or more, or render Mass. Gen. Law Chapter 143 Section 6 to be applicable. If you intend to initiate proceedings, please notify the undersigned by certified mail. Our mailing address is P. 0. Box 1079, Hartford, Connecticut 06143-1079 . Please reference the insured, date of loss and our claim number. Very truly yours, Ronald G. Gifford Property Claims Manager RGG/el GREAT AMERICAN INSURANCE COMPANY•AMERICAN NATIONAL FIRE INSURANCE COMPANY•AMERICAN ALLIANCE INSURANCE COMPANY•AGRICULTURAL INSURANCE COMPANY SUBSIDIARIES OF AMERICAN FINANCIAL CORPORATION