HomeMy WebLinkAboutMiscellaneous - 459 WAVERLY ROAD 4/30/2018Date ......... �2 .. A
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Tbs certifies that .......................................................
7- z o
has permission to perform .......... ............... VD. '�'J.nzk.4.t ........ 4")v . .
wiring in the building of ........... ...............................
at ......... North Andover, Mass.
Lic.No..I..f.A.-,?I/A ............ j . ..................... ...................
EEC'MICAL INSPEC76R
Check #
=10
Commonwealth of Massachusetts Official Use Only
Djne of Fire Services Permit N°. - j'
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
UV[Rev. 1/07) tlravw 1,10. L\
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 PRINTININK OR TYPE ALL INFORMATION) Date: a - z�" 09
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) :_! i7 CJ
Owner or Tenant
Owner's Address
Telephone No. Qi 8 -� �5 .1-1 7
Is this permit in conjunction with a bui ding permit? Yes No
❑ (Check Appropriate Box)
Purpose of Building W ' Utility Authorization No.
Existing Service!C! Amps / a p VoltsOverhead ro Und rd
g ❑ No. of Meters 1
New Service Amps / Volts Overhead
❑ Uncigrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Recessed Luminaires
of Luminaire Outlets
No. of Luminaires
No. of Receptacle Outlets
No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
Heaters KW
No. Hydromassage Bathtubs
OTHER:
Completion —frthe
o. of Ceil: Susp. (Paddle) Fans
No. of Hot Tubs
Swimming Pool Above
boe ❑
No. of Oil RD-Mers
No. of Gas Burners
No. of Air Cond. Ta
following table may be waived by the Inspector of Wires.
Totali: F--* _ ..........
Space/Area Heating KW
Heating Appliances KW
1V O. OI
Ballasts
o. of Motors Total HP
iranstormers KVA
Generators KVA
o, o mergency Ig g
❑
Battery Units
FIRE ALARMS No. of Zones
o. of Alerting Devices
tion/Alerting Devices
❑Municipal
Conneefinn ❑ Otlrer
No. of Devices or
:a Wiring:
No. of Devices or
No. of Devices or
O J Attach additional detail if desired, or required by the Inspector of Wires.
Estimated Value of Electrical Work: (�� (When required by municipal policy.)
Work to Stark �-I )Q 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 the ains and penalties of perjury, that the information on this application is
FIRM NAME: true and complete
LIC. NO.:"'
Licensee: Signature
(If applicable, enter "exempt " in the licens�ujvzber �hne)
LIC. NO.:Address: �- Bus. Tel. No.:
*Per M.G.L c. 147 s. 57-61 security work requires D Alt. Tel. No.:
' � Department'of Public Sa ety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance coverage normally
required by law. B y signature below, I hereby waive this requirement. I am the (check one) ❑o
Owner/Agwner El owner's agent.
ent
Signature Telephone No.g(- LIK J atyg 1 PERMIT FEE. $
k
R
4✓ ,
The Commonwealth of Massachusetts
k, 11 Department of Industrial Accidents
Office of Investigations
� a 600 If ashington Street
Boston, MA 02111
www.massgov/dia .
Workers' Compensation Insu
Applicant Information rance Affidavit: Builders/Contractors/Electricians/Plumbers
Please Print Lecobly
Nanle (Business/Organization/individual): C-) Pn r,
Address:
City/State/Zip :r� p�h y� (7�t^�7� Phone #:. Q .
'Any applicant that checks bo><# l must also 5if out the section below showing their workers' com
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ntractors must submit a new affidavit indicating such.
$Contractors that check this box must attached copensation per,+cy mrormation an additional sheet showing the name of the sub -contractors and their workers' c_^ p, policy .fi, �r2tion.
I am an employer that is providing workers $ compensation insurance for my employees: Below is the
informapolicy and job site
tion.
Insurance Company Name:
PoJicy # or Self -ins. Lic. #:
Type of project (required):
6. [] New construction
7. ❑ Remodeling
8. [j Demolition
p. ❑ Building addition
10. [❑ ,Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof-
13.❑ Other
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 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 cert�jjy under the pains and penalties of perjury that the information provided above is true and correct.
_. I lam ) 19
al
Officiat use only. Do not write in this area, to be completed byy city or town official
City or Town:
Permit/License 4
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
[� Contact Person: Phone 0:
Are you an employer? Cheek.the appropriate box:
1. ❑ I am a employer with
4. ❑ 1 am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a.sole proprietor or
have hired the sub -contractors
listed
partner_
on the attached sheet t
ship and have no employees
These sub -contractors have
working for me .in any capacity.
[No workers' comp, insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
requrred.]
3. ❑ I am a homeowner doing
officers have exercised their
all work
right of exemption per MGL
myself. [No•worke'rs' comp.
c. 1.52, § 1(4), and we have no
insurance required.] t
employees. [No workers'
camp, insurance required_]
'Any applicant that checks bo><# l must also 5if out the section below showing their workers' com
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside ntractors must submit a new affidavit indicating such.
$Contractors that check this box must attached copensation per,+cy mrormation an additional sheet showing the name of the sub -contractors and their workers' c_^ p, policy .fi, �r2tion.
I am an employer that is providing workers $ compensation insurance for my employees: Below is the
informapolicy and job site
tion.
Insurance Company Name:
PoJicy # or Self -ins. Lic. #:
Type of project (required):
6. [] New construction
7. ❑ Remodeling
8. [j Demolition
p. ❑ Building addition
10. [❑ ,Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof-
13.❑ Other
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 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 cert�jjy under the pains and penalties of perjury that the information provided above is true and correct.
_. I lam ) 19
al
Officiat use only. Do not write in this area, to be completed byy city or town official
City or Town:
Permit/License 4
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
[� Contact Person: Phone 0:
Information and Instructions
1
Massachusetts General Laws chapter 152 requires all emp)oyers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'however the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every .state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required." '
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance _
requirements of this chapter have been presented to the contracting authority,"
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not'the Department of
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 numberlisted below. Self-insured companies should enter their
self-insurance Iicense number on the appropriate iine. -'
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at thetottom
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 pennit 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 Investtigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE
Fax # 617-727-7749
Revised 5-26-05 www.mass.gov/dia
Paul S Petrie
459 Waverly Road
North Andover, MA 01845
August 3, 2007
Mr. Leon Leavitts
458 Waverly Road
North Andover, MA 01845
Dear Leon,
This letter is to inform you that your services will no longer be needed at 459 Waverly Road.
Another electrician will finish the job.
Sincerely,
W6, �- / 00
Paul Petrie
cc: Peter Murphy, Electrical Inspector
--lamb,
Date ..... A- .. e . . .. ;7...
.. .......... ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
/ &0 W I"a'4 VITFS
Thiscertifies that .............................................................................................
has permission to perform ......... A.Pa-f.p" .............................................
wiring in the building of ............. ......................
L -
at ......... 1-:5.2? .... VV4 AD ........................ . North Andover, Mass.
2360—S.
.. . ... ....
Fee ..................... Lic. No..�*&?.') .......... .......
E�i��R**IC'AL* INSPECMR
Check# 3 73Y
7203
A
x Commonwealth of Massachusetts Official Use Only
u Permit No.
Department of Fire Services
Occupancy and Fee Checked
y M
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05) (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 IN INK 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 or her intention to perform the electrical work described below.
Location (Street & Number) A, j ,A1/ei1� JP�
Owner or Tenant "A,./ �e f�t� Telephone No.
Owner's Address SA M ,
Is this permit in conjunction with a building permit? Yes 9-11, No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service /0 o Amps // p /,z 1Q Volts Overhead U 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 Insnertor of Wires
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Tota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool rnd. ❑ rnd. E]Batter
o. o mergency ig mg
Units
No. of Receptacle Outlets 30
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches /
.�
No. of Gas Burners
No. o Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pum
Totals
Number
Tons
No. of elf -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
Heaters KW
o. 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 Wires.
Estimated Value of Electrical Work: 30 a O.O a (When required by municipal policy.)
Work to Start: -2 - ?` 97 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 cove age is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE F BOND ❑ 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.:
Licensee: 1--f-aAl Z -,,P -AV, -tr—< Signature LIC. NO.: 41�2L 96 %
(If applicable, enter "exempt" in the license nus ber line.) Bus. Tel. No.:
Address: Al5ul �14 v e ✓ /e,y bra l R,� �6�/e Alt. Tel. No.:
*Security System Contractor Lice se required for this work; if applicable, enter the license number here:
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.
kWlk 10, 3 - /I- . Y7 FIll
Jan 02 08 02:12p Architectural Energies 978 box—;144 r•j
111j'
CHARLES HENRY GOLDsTEIN, N.C.A.R.B. - 200 SUTTON STREET, SUITE D5
ROBERT CHARLES ATWOOD, Assoc. A.I.A. NORTH ANDOVER, MA 01 845
December 28, 2007
Brian Levy, CBO
Town of North Andover
RE: ARCHITECTS AFFIDAVIT FOR ROUGH FRAMING
Addition & Renovations to a Single Family Dwelling
459 Waverly Rd.
Noah Andover, MA 01843
VIA: Fax® 978-688.9542
I hereby certify that 1 andlor my designated representative have performed the required
professional services pertaining to the rough framing work completed to date at:
Single Famlly Dwelling / The Petrie Residence
439 Waverly Road
North Andover, MA 01845
And to the best of my knowledge, information and belief the work that has been completed is in
conformance with the requirements of the Commonwealth of Massachusetts State Building
Code, 6#1 Edition, as applicable, the permit, and plans approved by the Town of North Andover
Inspectlonal Services Department and local ordinances subject thereto.
Charles Henry Goldstein, N. C. A. R. B.
MA
Date
T: 978.681 .0055 • F: 978.681 .1144 • WWW.ARCHITECTURALENERGIES.COM
G''W d ,...... 1,Wt AP.PAz ►►.(((
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . .......................... ........
has permission to perform .................. L .......
plumbing in the buildings of .......................
at ......... North Andover, Mass.
............
Fee . ..... Lic. No/
PLL�Mq`iNG INSPECTOR
Check Z
cy
1, e4
MASSACHUSETTS UNIFORM APPL ATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS �f
Date
;eOwnersNameA411YBuildingLocation Permit 77-
77,�
Amount
Type of Occuvancv
New Renovation Replacement
FIXTURES
Plans Submitted Yes 1:1 No
(Print or type) o% L/ Check one: Certificate
Installing Company Name Corp.
Address %
�� "`l Partner.
� 9s/�
Business Tele one j D �Fnm/Co.
Name of Licensed Plumber
Insurance Coverage: Indicate the to ofin rance coverage checking the appropriate box:
Liability insurance policy L Other type of indemnity ❑ Bond ❑
.insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner
I hereby certify that all of the details and information I have s
best of my knowledge and that all plumbing work and installa
compliance with all pertinent provisions of the Massachusetts
By Signature oyz
Type of PI
Title /51
City/Town LIcense NUMB
APPROVED (OFFICE USE ONLY
11 Z/ Agent 11
Kon are true and accurate to the
for this application will be in
Q of the General Laws.
License
Master Journeyman ❑
i 90
Date ....... / ....... 1.2.-.0.7 ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
/- C- ov /, &W/ I - -r,: r,
Thiscertifies that ........................................................... . ..............................
1 10,93#
has permission to perform ....... v ' (- 6 OR .........................
.................................
wiring in the building of ....... &� P,& -7P I 4F
...............................................................
at ..... ........ �/ ..... ................... . North Awdover, Mass.
Fee4�. Lic. No.,--;.� �10 ?4� ...........
Check # 7 1-57
7156
Commonwealth of Massachusetts Official Use Only
Permit No. {�
Department of Fire Services
Occupancy and Fee Checked
a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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 IN INK OR TYPE ALL INFORMATION) Date:
I l _ c�
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) 4Sy L IAyCrj�� f- Ivr /t4 .4, J, e, /19,4
Owner or Tenant f, r f Iye f j�'�c
Telephone No.
Owner's Address
S,g,n..e,
No. of Tota
Transformers KVA
No. of Luminaire Outlets
Is this permit in conjunction with a building permit?
Yes L� No
❑ (Check Appropriate Box)
Purpose of Building
Se r'1��'c e ,�,.oD Hep
%,a 64, �' Utility Authorization No.
Existing Service /00
Amps //e / ollo Volts
Overhead
Undgrd ❑ No. of Meters I
New Service /o r
Amps // 6 Volts
Overhead
Undgrd ❑ ' No. of Meters
I- Number of Feeders and Ampacity
,r
r
Location and Nature of Proposed Electrical Work: &,,14(,R-.1 Je,o-v,�
Completion of the following table may he waived by the tn.cnertnr niWirac
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
No. of Tota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In-
Swimming Pool rnd. ❑ rad. ❑
o. o Emergency Lighting
Battery 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
g
No. of Waste Disposers
Heat Pum
Totals
Number
Tons
KW
No. o 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. o
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 Wires.
Estimated Value of Electrical Work: ,�, d (When required by municipal policy.)
Work to Start: /- //- a % 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 the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: LIC. NO.:
Licensee: 1-eo,,V 1--e-AIII tf;j Signature � LIC. NO.: Gr1Z9 e7
(1f applicable, enter "exempt" in the license number line.) Bus. Tel. No.:
Address: P -Q) AJ���jte�,L�2a Alt. Tel. No.:
*Security System Contractor License required for this work; if applicable, enter the license number here:
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.