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Home My WebLink AboutMiscellaneous - 48 PHILLIPS COURT 4/30/2018 0 BUILDING FILE p�cc Date....A....f .. 3 ............ i y r10RTly TOWN OF NORTH ANDOVER PERMIT FOR WIRING s gCHUs This certifies That .............. .... .:......... ��. :. .............:................. has permission to perform .. ��?. .. I'I C.. ...... ................................. .................. wiring in the building of....... .......t'7.'.................................................... ................. � ..� ` at .......' ............................... ......................... ................, h Andover,'Mass. Fee.. ................Llc.No. ................. .��. . ELECTRICAL INSPECTOR Check# 1 n3 i 1258 -- � - ! - r IRA '\ C�i 001' M�q�/ ommor wealu o/mamaclwetfa Official Use Only c7 Permit No.�Z 5 8�" I 2epartment a/.,J`ire serelce9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. l/q (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME9,527 MR 12.00 (PLEASE PRINT M INK OR TYPE ALL INFO TION) Date: 21x11)5 City or Town of: To the Inspector of Wires: By this application the undersigned gives no of 'nor her inte tion to perform the electrical work described below. Location(Street&Number) ,,� Owner or Tenant Telephone No. Owner's Address7�fi Is thisj ermit in conjunction with a building permit? Yes-M No p � g p ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existings / Volts Overhead Service Amps ❑ 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: ddJ s�L 1 C-11A, r Completion o the followin table may be waived b.-lire Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n- ❑ 0.0Emergency Lighting rnd rnd. 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 and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers eat Pump um er ons o.o el- onta ne Totals: -- `---—T- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security ysterns:* No.of Devices or Equivalent No.of Water KW o.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or uivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,oras required by the Inspector ofJf`ires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,tinder the pains and penalties of perjrtry,that e inf qat on on this application is true and complete. FIRM NAME: �:�. .S / G�/�G . G+ /dxi, LLQ LIC.NO.: �%205`-- Licensee: �Zel SignatureLIC.NO.• "J' 20S- (If applicable,enter"exempt"i the icen a mmrber line.) Bus.Tel. Address: (sr�- cl),�Y It.Tet. o. A N *Per M.G.L.c. 147,s.57-6V,security work requires Dep ent of Public Safety"S"License: Lic.No. OWNER'S S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityinsurance coverage normally required by law. By my signature below,I herebywaive this requirement I am the check one)❑owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE:$ �J 1� • , ' i 1 � I 1 � � f ' r , 1 � � ' � ) � i ' � ' 1 ` .I ' � � ' 3 i i ' _ I � � r ` J Y `" -- � . .-�� :. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston,MA 02111 www mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �Please Print Legibly Name(BusinesslOrganization/Individual): Address: � '� City/State/Zip: 144 /.IY� Phone#: 9-- A 1.(e you an employer?Check the appropriate box: Type of project(required): Y I am a employer with c- 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] 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. 10. Electrical repairs or additions required-] 5. ❑ We are a corporation and its ❑ rep 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.❑ Other comp.insurance required.] i *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. lContractors 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 isproviding workers'compensation insurance for my employee& Below is thepolicy andjob site information. )' Insurance Company Name: /'kk /` - s`tN�• � Policy#or Self-ins.Lic.#. Expiration Date: Job Site Address: 0� ,/ I City/State/Zip: /�i��,r(l�/ 0,y-S 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. Ido hereby certify under the a' s anMnofpedury at, ' that the information provided above is true and correct Sipature• ate: Phone#. Off al use only. Do not write in this area,to be completed by city or town of,ficial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �f ., Commonwealth of Ma us,tts Division of Registrati >, Board of Electri MICHA 9 WAVE . NORTH A� _ { Master Elec ' 'a 0% : 21705-A 07/3112016 008772 License No. Expiration Date. Serial No. t r THEN0RF0LK DEDHAMGROUP® April 8, 2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1592393 Insured: 46-48 PHILLIPS COURT CONDO Address: 46-48 PHILLIPS COURT, NORTH ANDOVER, MA Policy No.: R121941 1A Loss Date: 04/07/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely,Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. p , Fax:(781)329-1818 Date -00 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . C".9 .. . . . . . . . . . . . . . . has permission to perform . . 04P6.�%f j' . . . . . wiring in the building of . . .� !'L%y. . . . . . . . . . . . . . . . . . . j at .Lt.b--q' . . P!qWCQ!9S- . � . . . . .North Andover, Mass. Fee ./2171�=. Lic. No. . .37,x . . . . . . . . r/ ELEPTRICALINSPECTOR Check# Z/ 7 11060 -A .— Commonwealth of Massachusetts Official Use Only Permit No. Department ®f Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/071 (leaveblank M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK \, I All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1.2.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: /Z \ 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) It") + 14 S NVIS Cr'T� Owner or Tenant U/0LL jl1/;� l /9n/7-Y Telephone No.178 3'-75F-- Owner's Address q7— 14CCAJ/r II\/C Is this permit in conjunction with a building permit? Yes ❑ No—p- (Check Appropriate Box) ri Purpose of Building Utility Authorization No. 13 �to —??—q Existing Service 10 d Amps 110 /M Volts Overhead Undgrd❑ No.of Meters n� <« New Service ��:: Amps 1 210 / 7A6 Volts OverheaEYFjo""'Undgrd ❑ No.of Meters G� Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe 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- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches Leto,of Gas Burners No.ofitiatig Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained / p Totals: * _. Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: J/ /Z 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 suchcove age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: 1NSU-UNCEBOND ❑ OTHER ❑ (Specify:) I certify,under the sins andpenalties o per wy,that the information on this application is true and complete. _ FIRM NAME: C- c— PCCC LIC.NO.: 339SZCo G- Licensee: / I?kC (J�CC-t9N.O Signature LIC.NO.: 39-,26 L (If applicable,enter "exemt"in the license number line ,c� Bus.Tel.No.: 01/ Address: qi(- /Y germ of q-t � // ,�f'•.t U F &7/94 `�-ZG Alt.Tel.No.:91 j `Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent PERMIT FEE: Signature Telephone No. �J_tJL'��1;.1..�41.�y'.tt'i�'-i�tt/�^.([p!'r.�Lji]l'(Y'�JyJ.J.I,�d�l�®q'�`�yj.�yt�j �, Iy�.!!e�.�CI.Q�,I'4 �®�JLo � • _ • _ .C7.FJJ.-71�A.�.q-4.LrH 9/.�1.Yl�J..fLtP.��®�•" .. � � «� a •+ Onoxt �2�sset�-� nspectoxs'�copzme�ts: ' '%t (lCnspec oxs"iszgaatae-oto o-Wals) Passea j C+aite�--j } to ns�ect o�xe�ttixe ( 0.00)--j �nspeetaJrS'cQ�ents: (ins iectoxsy,zgnature-xtoWiflals) date ` asp ectoxs'�coxam.entse [�nsp ectoxs� zgnatzzre o f nif aTs} Pate . IwAr al : rsec�.--j �'aile�.--j � ►fie-ans�ec�ionxequiYe�(�50AD)�j � ' 66CtOk'S9 eo)mixtepts: QkSpectoxalftgtUre-ioWLials) ])ate -/z— r • eri j azlar j }. 'ate Inspectionrpo ed($50.00)-[ :CiQ?"�g CQ�T.J,b1eX1t8: _ . • 5 • �ispectoxa° zgnatgre� oxnita3s} date n):Zl TA dN6 .dM,rVd)'R*i,,'U fT,VI)O)TrV AM TW,Fi'r OV,RTTV,W TFW.AZ?VA,Ta BE INSPECTED D Tq'ffOT 4 li The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): cm PC/- ig Address: 61/9MM dT col 6�0 f� City/State/Zip: J)PACUT , /✓110 OIE2C Phone#: q-)y (Otf Are you an employer?Check the appropriate box: Type of project(required): .J.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 1 2. I am a sole proprietor or partner- listed on the attached sheet. ? E]Remodeling f ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y P h'• 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10,[rElectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site nformation. nsuftce Company Name: 'olicy#or Self-ins.Lic.M Expiration Date: ob Site Address: City/State/Zip: attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby c tify rtm Date: ains and penalties of perjury that the information provided above is true and correct. 'i ature: hone#: 7 T G 014 S�01 2 9 Official itse 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 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 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 1-877-MASSAFE Fax#617-727-7749 tevised 5-26-05 www,mass.gov/dia 4 Date. . .. ... . f MOFTM pF4�.ao '6 . o? �` TOWN OF NORTH ANDOVER • . ' PERMIT FOR GAS INSTALLATION ♦ s .; r �9SSACNUSEt This certifies that . . . . has permission for gas installation . . . . .A„4144pr,r, . . in the buildings of . . .allvlv. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .�J�� . . tMAr. Azr , North Andover, Mass. Fee. . o.W Lic. No..,S 7s . GAS INSPECTOR 3 Check# 3 Z i � 8279 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO OASF117IN13 (Print or Type) ' M69TA WONCIZ , Mass. DateL7/�S 21 Z Permit # Building Location• -48 PHILLIPtS C?, Owner's Name RA&PPI) CAKQ _ " MOZ 8 AMDOVE 'I P, _Type of Occupancy 2 FAMIL�� New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N a Z Q vi N N U N rt VI Q O N = l�- W w a O U H 1s z a a Z ? o t+ W a m N f Q ¢ O O 0 H N 0 W Q y Z 1- to a G > 4 N a W Z V W N W Q rz O. (] W W W N Q S a c tl cc W W x y? C7 t- ZZ �, W W O > W t-• U .� �. W z. e W a �' r as Z o Z W o tr, s Q W > CC W 2, Q ccQ 0. is '.x O c7 s u. a c tl .aa v y c a h o SUB—BSMT. BASEMENT Z 7 ST FLOOR 2ND FLOOR ,t N 3RD FLOOR V) 4TH FLOOR Q STHFLOOR coo 6THFLOOR 7TH FLOOR STH FLOOR Installing Company Name COLUMBIA GAS G5 MASSACHUSETTS Check one: Certificate # Address 55 MARSTON STREET �C] Corporation 1862 LAWRENCE, MA 018 4 1 - 2312 [1 Partnership Business Telephone q 7 691- 64O 6 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent F1Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/ T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 3745 City/Town Journeyman APPROVED OFFICE TSF BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE . NO. APPLICATION FOR PERMIT TO DO GASFITTING J NAME & TYPE OF BUILDING . „ LOCATION OF BUILDING a PLUMBER OR GASFITTER_ LIC. NO. r t � PERMIT GRANTED — DATE _19 GA-S INSPECTOR i e i