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HomeMy WebLinkAboutMiscellaneous - 45 WOODBERRY LANE 4/30/2018 (3)V Date ...... !......31 .... 2........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ ( .... ... ✓.............`-'�! ........................................................ has permission to perform ....... ........ ?.............................................................. wiring in the building of.........(� 1��4..............UJ:.1' at ............. !....................... , Nh dover, Mass. ........ Fee..S ' Lic. No. �y�..�� �... ....................... l .. /...- ELECTRICAL INSPECTOR . 5-b .Check # '3 � - 1 344-1 Commonwealth of Massachusetts Official Use Only t' Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 C 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATIOM Date: 41113 1�O/b City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of hi � or her intention to perform the electrical work described below. Location (Street & Number) j - llioodToGY' e Owner or Tenant L 1t ' i tY Wtl'Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building I 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 ;l Location and Nature of Proposed Electrical Work: ria A fv wyw C1T,o )Q/4 e Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cel 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- ❑o. rnd. grnd. of Emergency.Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 3 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 Totals: Number.. Tons ......................................... KW No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts Data Wiring: 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 WYres. Estimated Value of Elecrical Work: Ob (When required by municipal policy.) Work to Start: l ) b 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 cover5ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:. LIC. NO.: ) yyi3A Licensee: � .�� ScA<dV Signatur LIC. NO.: 3SU3o!';- (If applicable, enter t"_ in the license number i e. Bus. Tel. No.' �7836111A Address: 3 (e1'd � 34% CA,= , (,-� �� � 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 �EIiMIT 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 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP CTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: r Date: FINAL INSPEC ON: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ? — —A6 DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com r y The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 .� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/fndividual): Address: // 3 el e4i Sail- City/State/Zip: iAA ()(Kff Phone #: Are you an employer? Check the appropriate box: 1. ❑r-1 employer with , . employees (full and/or part-time).* 2.[ J sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' compAnsurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we haye no,.eployees ; [No workers' comp. insurance required.] f?YAl Type of project (required): 7.-[]Nee,construction 8. odelirig 9. ❑ Demolition 10 ❑ Building addition 11.D Electrical repairs or additions 12: [] Plumbing repairs or additions 13. Roofrepairs 14.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit #tris affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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, %ey must provide their workers' comp. policy number. I airs an employer that is providing workers' compensation insurancefor my employees.' Below is'thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. tic. #:. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and r thes andpe ties ofperjury that the inform atio n p ro v ided above is true and correct Signature: Date: 1.3 ��_Xb Plhnne #. 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): i 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 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 & trustee of an individual, partnership, association or other legal entity, employing employee's. 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 requiured." 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 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Date....... �- o TOWN OF NORTH ANDOVER PERMIT FOR WIRING certifies that P,44P,-1S This certi ...............................�''......................................................... has permission to performZpiE,1!Yf�rls!.tt%2 5YS wiring in the building of .................W..... ................. . ..... ............... at........... UU s Lic. No. Check # _ ,( 8671 .1 ..r.: ,e .................. North Andover, Mass. .3................... ................. ELECTRICAL INSPECTOR y Commonwealth of Massachusetts MM Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7 Occupancy and Fee Checked [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), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his orhef intention to perform the electrical work described below. Location (Street & Number) �00 D RU -1 IP !/ % A Owner or Tenant Owner's Address C6 Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. Yes ❑ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work:„ 1±� , Z A TSS LLP � ;l,Jr fes! � , / l� o /C Co letion o the followin table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Sus/. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above In- o. o mergency ig g ernd. rnd. ❑ Batte Units -- No. of Receptacle Outlets No. of On Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. -of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Totons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No. of Self Contained Totals: _._.....__......._.....__._. Deteetion/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No. of WaterNo. of No. of Devices or Equivalent . Heaters KW NoofSi s Ballasts . Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total Hp Telecommunications Wiring: OTHER: No. of Devices or E uivalent d Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: B - vti (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE OVERAGE: 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 a is in force, and has exhibited proof of same to the permoffice. it issuing oce. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the ains and penalties of perjury, that the information on this application is true and complete FIRM NAME: /n ` ' / G �. LIC. NO.: Licensee: S ,p��Z69,9, Signatur LIC. NO.: (If applicable, enter "exempt " in the license number line.) /$ d� Address: e-� ,� s �� Bus. Tel. No. `f �_ Alt: Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 11 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r j www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A,nislicant Information Please Print Legibly Narrie (Business/Organiration/individual); ���/ s J��C�G%�Zlf •�j{•`�.. Address:_ --?,g 7 City/&6/Zip: lLf �i �/�•�Se1�`111 Phone #:� 7r _ Are you an employer? Cheek.the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): (full and/or part-time).* 2. el have hired the sub -contractors 6. ❑ New construction l i" I I am.a.sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. E]Demolition working for mein any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition regtnred-] 3. ❑ I am a homeowner doing officers have exercised their 10• ectrical repairs or additions all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No -workers' comp. insurance required.] �I 1..employees.[No c. 1.52, § 1(4), and we have no workers' 12. Roof ❑ repairs camp, insurance required_] 13.❑. Other -rr•• -�••• ••.o, Wry w oox If i must also tut out the section below showing their workers' 'compensation policy information t Homeowners who submit this affidavit indicating they are daring all work and then hire outside contractors must submit a new affidavit indicating such. 4C011tractors that check this box must attached an additional sheet showing the name of the subcontractors and their workem, comp• pchcq information. 1 am an employer that is providing:workerc' 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: 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 e. 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 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: f11 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 insumnce'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 requiredto 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' corr.pensation policy, please call the Department at the number. listed below: Self-insured companies should enra the it 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 bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-45 Fax # 617-727-770 www.mass.gov(dia Date....l...'. B� IV 40 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING -,; . '' • r This certifies that....S FG ! ... �%% i ....... ! ............... .......... has permission to perform ..../,—/ l��!!U✓�Sp��..?i%! wiring in the building of......r.1........................................... ..1 .....................e...... , North Andover, Mass. Fet" '-...... Lic. Noll 972W.�<-� 1...�t?�1;��!4.a�...... ,, _ ELECTRICAL INSPECTOR Check # �3%s 8563 ii -%-\\ Commonwealth of Massachusetts Department of Fire Services UIV BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 9T1 - j Occupancy and Fee Checked Cev. -1/07] (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 W INK OR TYPE ALL E&ORMAT1019 Date: 01 2 Q 400 R City 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) '7 5 WOOD 13LJ i _4 A A M C Owner or Tenant (A U I kny ('Ly Telephone No. Owner's Address � M Is this permit in conjunction with a building permit? Yes No �E] (Cheek Appropriate Boz) Purpose of Building jZLS t C'/�P Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters N be um r of Feeders and Ampacity Location and Nature of Proposed Electrical Work: o. of Recessed Luminaires 1 "?., of Luminaire Outlets No. of Luminaires I T (In e 1v the of Cer7.-Susp. (Paddle) Fans of Hot Tubs 1Y100f L i table maY be waived by the Ins ector o Mires. No. of Total Transformers KVA Generators KVA Swimming Pool `'Dove ❑in - m nd_ amai ❑ No. of Receptacle Outlets I ` No. of Oil Burners No. of Switches + `� No. of Gas Burners No. of Ranges i No. of Air Cond. Tons No. of Waste Disposers eat PUMP I umber ons I Totals: No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Appliances KW No. ofater, Heaters o. of No. of Signs Ballasts . No. Hydromassage Bathtubs No. of Motors Total HP ALARMS 'No. of Zones .of Alerting Devices . of Self -Contain tection/Alerting Devices Municip E3 Conn ection ❑� .unty Systems.* No. of Devices or Equivalent :a Wiring: No. of Devices or Equivalent ecommumcations No. of Devices or E=nt m Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: Clow, (When required by municipal policy.) Work to Start / /Z,-0 -0 / 0 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 covea 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 andpenalties ofperjury, that the information on this application is true and complete FIRM NAME: S-1 AT e— L- 01J 4 h 4 C•fitJLi c,st !. Licensee: ? LIC. NO.: y �Z A�'►1� � � �c Aa�leN✓{ � L i Signature LIC. NO: 3Y�1S V G (If applicable, enter 11t 11 in the license number liner u� �A Bus. Tel. No: � • y q 3 Address: 1 In 7�A�sn �'l • Qie.9 i � r *Per M.G.L c. 147, s. 57-61, secure work ' Alt. Tel. No.: - + S • 7t 5'v ty requirs 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: $ u X02 it 11 a n M it I IE H M a 2 Silver Ledge Road, Newbury, MA 01951 Office: 978-462-4331 - Cell: 978-973-2366 - Fax: 978-462-5528 - email: jfix@comcast.net January 21, 2009 Inspector of Buildings — Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Residential construction at 45 Woodberry Lane, North Andover, MA Dear Building Inspector: Today I visited the Faulkner residence at 45 Woodberry Lane in North Andover to observe the construction of the renovation. During my site visit I observed that the structural work - including the steel and LVL beams - appeared to have been constructed in general accordance with the design drawings, dated 11/21/08, prepared and stamped by me. If you have any questions, please feel free to contact me. I Date ... / . ........ NORTH TOWN OF NORTH ANDOVER IL PERMIT FOR WIRING This certifies that ..... .... 2 ...................................... has permission to perform ....... I .............................. wiring in the building of ....... ................................ .t .......... ............ �'/ ...... North Andover, Mass. Fee IT ...... Lic. No ....... ELECTRICAL INSPE66R Check # 6911 A l� =—, The Commonwealth of Massachusetts C+ Department of Public Safety f BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION (PLEASE PRINT IN INK OR City or Town Of ---- The undersigned applies fc Location (Street 8 umbo Owner or Tenant Q" rAwner's Address___ o;C3— Office Use Only axPermit No. q l% Occupancy & Fee Checked 3/80 (leave Wank) FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electncal Code, 527 CMR 12!00 E ALL INFORMATION Date N1 r +40�� a permit to perform the electrical work described below. Wood beaq �� iQ-enbor Q' Is this permit in conjuration with s building permit yes ❑ no Purpose of Building Utility Authorization No._ Existing Service—Amps _J Volts New Service Amps / Volts Number of Feeders and Ampacity. Location and Nature of Proposed Electrical To the Inspector of Wires: (Check Appropriate Box) Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters iS )WQ, hA -V- OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ r heave submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE L�1 BOND ❑ OTHER ❑ (Please Specify) TT (Expiration pate) Estimated Value of Electrical Work S �V I -/— Work to Start Inspection Date Requested: Rough Final_ _ Signed under the penalties ofperjury: FIRM NAME 769," �51 C r✓ I LIC. NOJ L fT License e1-7-01 .,� 4 �`fz'Fili��S Signature ,1 LIC. �NgO. i Address { AOR .J / f ~L-� tel. No. 9i 1u Alt. Tel. No. d ib OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. and that my signature on this aoDlication waives this requirement. Owner Agent (Please check one) TOTAL No. of lighting Outlets No. of Hot Tubs No. of Transformers KVA Nob. of htin Fixtures AboveIn Swimmi Pool md. ❑ and ❑ Generators KVA No. of Emergency Lighting No. VReceptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets -. No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and TOTAL No. of Ran es No. of Air Conditioners TONS Initiating Devices No. of Sounding Devices HEAT TOTAL TOTAL No. of Disposals No. of Pum TONS KW No. of So" Contained Detection1tounding Devices No. of Dishwashers Space/Area Heating KW f Municipal Local ❑ Connection ❑ Other No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. of H ro Massae Tubs No. of Motors Total HP OTHER INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ r heave submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE L�1 BOND ❑ OTHER ❑ (Please Specify) TT (Expiration pate) Estimated Value of Electrical Work S �V I -/— Work to Start Inspection Date Requested: Rough Final_ _ Signed under the penalties ofperjury: FIRM NAME 769," �51 C r✓ I LIC. NOJ L fT License e1-7-01 .,� 4 �`fz'Fili��S Signature ,1 LIC. �NgO. i Address { AOR .J / f ~L-� tel. No. 9i 1u Alt. Tel. No. d ib OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. and that my signature on this aoDlication waives this requirement. Owner Agent (Please check one) . a f .. �, �. .. . ,, Date. �7 � e?. . OWN OF NORTH ANDOVER mom PERMIT FOR PLUMBING This certifies that ............. ............................. has permission to perform plumbing in the buildings of .... .... ......................... at / ................... .— ........ North Andover, Mass. . . . . eFe�.. Lic. No. . . ....... PLUM GINSPECTOR Check # 7970 Y CIVTI Mao MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: tb- �%tJ jG�''`{-�`e'L- MA. Date: 4—t- Permit# Building Location:� �/� � - ��� Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes ❑ No ❑ CIVTI Mao INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Io EJ you have checked Yes, please indicate the type of coverage by checking the appropriate box below. / A liability insurance policy 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner El Agent ❑ � Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the hest of my �•••��a� �••� �•a• ajim,nup[ 19 VVUI K dnu msianauons performed under the permit issued forth is application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i By Type of License: Title tuber ignature of Licensed Plumber City/Town Waster 1 APPROVED OFFICE USE ONLY ❑Journeyman License Number: ��, Z z z J 0 N W U) d W Z FQ- coY Q to J Q = 0 W t7 W z Q � to = 0 m < a W to � W z Q Y to OJ if 1-- O W W � � � NO o Q �' z W = 0 0 O W tY z 0 (q J c7 0 a. Q Q Q p H>> O O O z z Q Q Q= Q m m <L (7 2 Y_j J W W In I-- 53., 3� 0 SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3"'L) FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: Chek Oce Only Certificate # City/Town:-C�2G-K�.. State: �Il C7 Corporation Business Tel: Cell: a 5- ,�—P Zip Code: g;;d G Fax • ❑ Partnership _ ❑ FirmlCompany Name of Licensed Plumber:-�-+—�^ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Io EJ you have checked Yes, please indicate the type of coverage by checking the appropriate box below. / A liability insurance policy 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner El Agent ❑ � Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the hest of my �•••��a� �••� �•a• ajim,nup[ 19 VVUI K dnu msianauons performed under the permit issued forth is application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i By Type of License: Title tuber ignature of Licensed Plumber City/Town Waster 1 APPROVED OFFICE USE ONLY ❑Journeyman License Number: ��, Town of Andover Massachusetts (Office Hours 8: 00 A.M. to 10:00 AM) Gas & Plumbing Fees Effective March 12, 2003 ❑ NEiv: New Constriction and Additions ❑ RENOVATION: Plumbing within the existing system ❑ REPLACEMENT: Removal and replacement of a fixture to the existing piping "'ALL TENANT FIT -UPS ARE CONSIDERED "NE�V" FEUMBING FEES New Domestic Construction — up to 3 Units $100 plus $5 per fixture DNEW New Domestic Construction — 4 units or more $200 lus $5 er fixture DNEW Renovation (Domestic) $50 plus $5 per fixture DREN Replacement (Domestic) Existing Fixtures ONLY $10 plus $2 per fixture DREP Backflow Preventer (for boilers) $10plus $2 er fixture DREP Backflow Preventer (for irrigation systems) $25.00 DBAK New Commercial /Industrial $200 lus $5 per fixture CNEW Commercial — Renovation $100 plus $5 per fixture CREN Commercial Replacement — Existing Fixtures ONLY $50 plus $5 per fixture CREP Backflow Preventer (for boilers) $50 plus $5 per fixture CREP I Backflow Preventer (for irrigation systems) $25.00 CBAK Re -inspection Fee $25.00 INSP GAS FEES New Domestic Construction — up to 3 Units $75 plus $5 pera DREN liance DNEW New Domestic Construction — 4 units or more $150 plus $5 per appliance $10 plus $2 per fixture DNEW Renovation (Domestic) $50 plus $5 pera SCAT INSP liance DREN Replacement (Domestic) Existing Appliances- ONLY $20 -plus $2 per appliance DREP Gas Boiler / Furnace / Conversion Burner (Domestic) $50 plus $5 pera liance DREN Neer Commercial / Industrial $150 plus $5 pera liance CNEW Commercial — Renovation $100 plus $5 perappliance CREN Commercial Replacement — Existing Fixtures ONLY $50 plus $5 pera liance CREP Gas Boiler / Furnace / Conversion Burner (Commercial) $100 plus $5 per appliance CREN MISCELLANEOUS Gas Log/Fire Place $50 plus $5 pera liance DREN Gas Stove/Heater $50 plus $5 pera liance DREN Utility / Bar Sinks $10 plus $2 per fixture DREP Capped Sewer Lines I Re -inspection Fee $25.00 $25.00 SCAT INSP ^��'{ZPCP fees are llCe!_7' if the pPt"1-Fllt iC f(,ir tnic �vnrk Qnly. Af the perP.;;t rnGi 'tee v^iiie'i N ' b _ L S lilmvru VYGr k, the fee charged will be the fLYture fee which appears under renovation, replacement or new work (52.00 or 55.00) A FIX ENGINEERING JOB 2 Silver Ledge Road SHEET NO OF Newbury, MA 01951 CALCULATED BY DATE' 1 978-462-4331 Email: jfix@comcast.net CHECKED BY DATE SCALE ap, tv lax 3&9 (rye) - 41/t 8Z,1e(C,01,wV TO (;z) /, �IA'17 yzvL � PFMDM204-1 "9)eEts)205-1(PWW) 4050 4050 4050 405-0 Rasue'Vese2wmdoas 0r; Rg';Z3tb W 4 Mrdnl. Ma otran alW4 spared W .9 Re-v=e —ir47w SUNROOM -imam -mW saNa;ad ftvo dac, wi klt= ' Remove ways Remove �'.rtlpw ode atetl team KITCHEN clan Vicla WM icea OFFICE PLAYROOM W 3530 2268. 3540 FAMILYROOM 3440 Date. . O� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... .. ,.1.7e:-� Ie -! .......... has permission to perform...`1 !-!� ............ plumbing in the buildings of .j at %..E.................. , North Andover, Mass. Fee��? .... Lic. No'�'f/d ;:-?a ............ PLUV'NINSPECTOR Check # /i�/� 7090 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) d 10 Building ,Mass. Date s0�D Permit# /� Building Location , `sem- woo � ��'rT_ Owner's Pap, tr8' e�%r �S :�4Type of Occupancy New ❑ Renovation ❑ Replacement FEATURES Pians Submitted Yes ❑ No ❑ Ingtaliing Company Name_j"✓�l1� �` tlp,4C�,, �� �(�. [ AAF Address g b pr .'AJCPjj f&J - Business Z'r/o: Certificate 6---,porneation / g � / `%�r U Partnership Cl Firm/Co. _ Name of Licensed Plumber INSURANCE COY AGE: I have a current ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes No ❑ If you have checked yes, please in�di to the type of coverage by checking the appropriate box. A liability insurance polic CY Other t of Y type indemnity 0 -Bond ❑ OWNERS 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: Slaiiit—ure ne or own 'a Aaent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information i have witted (or entered) in above pli ation are true and .accurate to the best of my knowledge and that all plumbing wo s Ilations performed under th r issued for this application will be in compliance with all pertinent provisions of a a usetts State Plumbing Cod a Ater 142 of the General Laws. By Sign ure n um er Title Type of License: Master Journeyman ❑ Cm`frown License Number M /D �■■rrrrr■■■rrrrrrr■■rrrrrrr■�■ �rrrrrrrrrrrrrrrrrrrr■r■rr■■ ... - ■r■rr■■■■rrrrrr■rrr■■�■■■■�■ .. - ■■MESON r■r moose r■■■■■■■■■■r ...MINr■■■r■■■■M■■■■■■■■■■r■■■■r ... ■■■■■■■■■■■■rrr■■■■■■r■■■■�■ ■ ■rrrr■■■■■■■■■■i Ingtaliing Company Name_j"✓�l1� �` tlp,4C�,, �� �(�. [ AAF Address g b pr .'AJCPjj f&J - Business Z'r/o: Certificate 6---,porneation / g � / `%�r U Partnership Cl Firm/Co. _ Name of Licensed Plumber INSURANCE COY AGE: I have a current ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes No ❑ If you have checked yes, please in�di to the type of coverage by checking the appropriate box. A liability insurance polic CY Other t of Y type indemnity 0 -Bond ❑ OWNERS 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: Slaiiit—ure ne or own 'a Aaent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information i have witted (or entered) in above pli ation are true and .accurate to the best of my knowledge and that all plumbing wo s Ilations performed under th r issued for this application will be in compliance with all pertinent provisions of a a usetts State Plumbing Cod a Ater 142 of the General Laws. By Sign ure n um er Title Type of License: Master Journeyman ❑ Cm`frown License Number M /D 014r. Crommmuluento of Magoor4artto Ileparttt int of rublir %fetq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office Use Only Permit No. Occupancy A Fee Checked o 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Data 1 ±� 00 or Town of NORTH ANDOVER To the Ins 4ector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 45 W6w- c�`D"er � L/y Owner or Tenant S; h O s k Owner's Address Is this permit in conjunction with a building permit: Yes19 No ❑ (Check Appropriate Box) Purpose of Building S nM11e PAS+1�l Utility Authorization No. y, -� Y Existing Service 220 Amps Volts Overhead ❑ Undgrnd �- New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work W � ru 0U AIU NQS -3 SefSa,v No. of Lighting Outlets `{ No. of Hot Tubs 11 No. of Transformers TotalKVA No. of Lighting Fixtures L� Swimming Pool Above In- ❑ ❑ I grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacl6 Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers ( Space/Area Heating KW Detection/Sounding Devices LocalMunicipal E]Other ❑ Connection 1 No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 1_�, NO = I have submitted valid proof of same to the Office. YES = NO = If you have checked YES, please indicate the type of coverage by checking the appropriate box: �,V INSURANCE �K BOND = OTHER s=, (Please Specify) T 6 xpiration Date) Estimated Value of lectrical Work S ©' v (E Work to Start 3 Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. Licensee �� _>f(-VffVS Signature `LIC. NO. �6a A n7 -9 /%i'%tN � A4, A',y-1 �%�o� IV --BAt. Tel. No. sdg t���% �7g�/ Address - "'�` OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- °J quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent r, (Please check one) V� Telephone No. PERMIT FEE S C (Signature of Owner or Agent) x-5565 .: 1121661 NORTH ot O F SSAC14USEt Date ... 7..i%....,7� 4 TOWN OF NORTH ANDOVER A r PERMIT FOR WIRING O This certifies that ...... -?..� O ..... - :.....s .................................... 5 has permission to perform ......�.N....`.'� e�^� � . c. -P . c�+� .. t 0 .. wiring in the building of ......... ?19...fit ......................................................... at ......S!... ......4..... .North Andover a qq s d' /�� �y r .. Lic. No. Fee... ......:....... ............. ,,.�...�,,,,........ ........ ... . 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