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HomeMy WebLinkAboutMiscellaneous - 47 HIGH STREET 4/30/2018 I Date........ 40RTH A 0 TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING ,ssACHU This certifies that ................. .. ............ ............................................. has permission to perform ......................................................................................................... wiring in the building of......... 4. ........... .0.......................................... at .....L17 ///1 5"77 North Andover,Mass. ............................... ................................................. cs Fee.... .......................Lic. No. ....../ ...................... ......... p cp /! ELECTRICAL INSPECTOW V Checko 12474, t%ORTFI Town of North Andover D.B.A. —Zoning Compliance Form �! �RwTan 978-688-9545 �SSACH�7`��� This form must be reviewed with the Inspector of Buildings. Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday. Applicant Name: Lz u kvi Name of Business: 0i `-� �r Ac . . Address of Business: �1 ) i i Zoning District Lot DOC) Phone: ��`� �a a� Email ��1 e ` 5 �i CE11 C6`n Nature of Business: Do you own this property? Yes No ) If no, written permission is required from your landlord. Will you have clients coming to this property No es Will you have any employees? Yes CNo _ Will you have any major deliveries? Yes No ' Description of Business Activity(Must be Completed) Glc S t Signature of Applicant For Signage Refer to North Andover Zoning Bylaw Section 6 The proposMwe e ' s zoning district. Issue y ate i 5/172017 Town of North Andover Mail-East Coast Photo Workshops � nett _"'_ NOR ' 'A1 �OVR Massachusetts JDonald Belanger<dbelanger@northandoverma.gov> East Coast Photo Workshops 1 message David Steinbergh <dsteinbergh@rcg-Ilc.com> Wed, May 17, 2017 at 1:28 PM To: "dbelanger@northandoverma.gov" <dbelanger@northandoverma.gov> Cc: Tina Santoro-Smith <tsantorosmith@rcg-Ilc.com>, Lori Muller<lod@theia-studios.com>, Jodi Feil <jodi@theia- studios.com> Dear Mr. Belanger, As Manager of RCG North Andover Mills LLC (the Landlord at East Mill North Andover), I hereby represent that Theia Studios at 47 High Street#104 has permission to operate photography education classes under the new entity, East Coast Photo Workshops, in their space. Please let me know if you have any questions or want further documentation. Thanks, Dave. David Steinbergh RCG LLC 17 Ivaloo Street Somerville MA 02143 617 625 8315 www.rcg-llc.com httos://m ai i.aooale.com/mai I/u/0/?ui=2&i k=3e210fea79&view=pt&search=inbox&th=15c177297dd01c0d&si m l=15c177297dd01 cod 1/1 North Andover MIMAP May 17, 2017 L, 31 fD; a ;o R4: Stceet. 13, e .Ar, 00 p' P \\\•\\\\\ c,.\�\ \\\:,.\\ R75 ;r xw.��w CO qj T25 J Ctr� �r Ssrstt�'` o —eat 0 A� _heti `� ��Sr^� ,�" fA.al.•:_ RS ��� ,Elrricrest,R f � 1 „f - I 0 MVPC Be Zoning Overlay Zoning C1 Municipal Boundary 13Adult Entertainment Dlstdc Busine s 7 District MachineShop Vlltage Ove C Busine 5 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Rail Line 0 Watershed Protection Dist 13 Bu sia s 3 Dlstdd Meters Data Sources:The data for this map was produced by Merrimack Interstates Q Histodc Mitl Area ■Busine s 4 District NORT#q Valley Planning Commission(MVPC)using data provided by the Town of Interstate 0 Medical Marijuana M Gene Business District Of ao North Andover.Additional data provided by the Executive Office of —Major Road ©Downtown Overlay Disbid D Pa Commercial Oev <« ' �O Environmental AHairs/MassGIS.The informeflon depicted on this map Is Roads i�',Historic District Conic Development Dist j. • OL for planning purposes only.It may not be adequate for legal boundary Osgood Smart Growth(40 C:Conic Development Oist O to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER l i Easements Hydrographic Features O Cortid Development Dist �' P MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industd I t District O Parcels Streams Ind sul 12 DisMd « • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY C ad dustd 13 District } i j OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands 13 Indus ui I S District 01 < _. �r� 1 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF r,Exempt Lands Reside ce 1 District « THIS INFORMATION Resido ce 2 District ,SSACMUSEt f'Rn_cide ce 3 District de ce 4 District 1"=389 ft {A}de ce 5 Distdd a Y rdo ce 6 Distdd e Eesidenfial District i 4. b Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. jZ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.m7] (leaveblank 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;her}'ktentio to pprform.the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjuncti/o�nnn with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building W 0AM Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived bythe Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets /4p No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices �J No.of Ranges No.of Air Cond. Total No.of Alerting Devices !/ g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection a No.of Dryers Heating Appliances KW Secu dNo.o De ices 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 Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wfres. 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 equiv4lent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under fhepainv anilpenalfigspeEA6 nform this application is true and complete. FIRM NAME: _ /1/ LIC.NO.: Licensee: Signature LIC.NO.: (Ifapplicable,ente "ex t h 1' /i/ ber Bus.Tel.No.• wev Address: (r(� Alt..Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of P-513lic 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 EARMITFEE.- $ Signature Telephone No. 1 ❑ 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 1 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($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: • Pass[N Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass /t M Failed Re-Inspection Required($.)❑ Inspectors C ments: i Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: "d. lootl Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com i The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass govI dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electrricians/Plumbers Applicant Information Please Print Legibly Name(Businesslorganization/Individual): "V LI 0�4 Address: City/State/Zip: Phone Are you an employer?Check the appropriate box: Typo of project(required): 1. I am a employer with�_ 4• El am a general contractor and I 6. El New construction Y(( employees(fulland/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- .. listed on the attached sheet.t ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. ElWe are a corporation and its 10.F1 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.❑Plumbing repairs or additions CN.lf m se [No comp. c. 152,§1(4),and we have no 12.❑Roofrepairs Y insurance required.] employees.[No workers' 13.❑Other comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. I Homeowners who submit this affidavit indicating they Lire 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the,policy and job site ' information. Insurance Company Name:. y 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 requiredunder 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify u r thep ins and aloes ofperjury that the informationprovided above is true and correct. Simature: Date: r hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - Contact Person: Phone if: 1\ Information and Instruction's ion's 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 ofpublic 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 maybe submitted to the Department of Industrial Accidents for confuniation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed 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. Anew affidavit must be filled out each year.Where a homeowner 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 COMMo>uwoalth ofMassachme s Dopafteat ofIndustrial Accident.- Office AccidentsOffice of1n1vestigatiom 600 Washington Street Boston}MA.02111 TeX,#617-727-4900 ext 406 or 1-877�NlASSAFE Revised 5-26-05 Fax#617-727-7749