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HomeMy WebLinkAboutMiscellaneous - 479 STEVENS STREET 4/30/2018 479 STEVENS STREET 210/096.0-0013-0000.0 I I Phone: 978-632-2660 Fax: 978-632-2662 JAMES A. TRUDEAU Adjustment Service Inc. P.O.Box 7 Gardner,MA 01440 claimsnu,trudeauadixom Notice of Casualty Loss of Building Under Massachusetts General Laws, Chapter 139, Section 3B October 26, 2015 J12 uilding Inspector 0 Main Street North Andover,MA 01845 Board of Health 120 Main Street North Andover, MA 01.845 Fire Department Dept. of Records 124 Main Street North Andover,MA 01845 Insured: Jessica& David Tamarin Loss Location: 479 Stevens Street,North Andover,MA 01845 Insurance Company: The Concord Group Ins.Companies Policy No.: 1095250 Date of Loss: October 19,2015 File Number: 15-13954 Claim Number: 0001171818 Type of Loss: Property Damage 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, Chapter 143, Section 6"to be applicable. If any notice under"Mass. Gen. Laws, Chapter 139, Section 3B" is appropriate, please direct it to the writer and include a reference to the captioned insured, location,policy number, date of loss, and file or claim number. Claim has been made involving loss, damage or destruction of the above-captioned property, which may exceed $5000. If any notice under Massachusetts General Laws, Chapter 175, Section 97A is appropriate, please direct it to the attention of this writer and include a reference to the above-captioned insured, location,policy number,date of loss and claim number. On this date, I cause copies of this notice to be sent to the person(s) named above at the address indicated by first class mail. Sincerely, Joshua M. Trudeau Claims Adjuster / 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the v `\ 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,S-3L. Permits shall-be limited as to the time of ongoing construction activity,and may be.deemed-by the-Inspector-of Wires abandoned.and.irnvalidifhe.—_. ._ 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 entitystated 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 puipose 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. f Rule 8—Permit/Date Closed: _ **Note:Reapply for new permit-, 0 Permit Extension Act—Permit/Date Closed: \ 0003 Date —.... f l... NORT1� `".'�"°° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ♦ o �'a ,S$A HUSE� This certifies that j. ................... f has permission to perform ......L- wiring in the building of........�/g�1�1 .l.. ............................................. at.... -7.I....-�� lZ ............ .....,North Andover,Mass. pC7 Fee:O............. Lic.No...J.T??!! ..... W ...�..rf/ ... ................ ELECTRicALINSPECTOR Check # / i � Commonwealth of Massachusetts Official Use Only Department' of Fire Services Permit No. 1410-3 BOARD OF FIRE PREVENTION REGULATIONS 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_ C), 7 CMR 12.00 (PLEASE PAINT ININK OR TYPEALL INFORMATIOA9 Date: �� City or Town of: NORTH ANDOVER To the Inspector of Wines: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) q{ 1 `L/- e7/-'J_3 1 Owner or Tenant OP 'D f- m -T-.0 Telephone No. 8 �3-- 4y1 Owner's Address Is this permit in conjunction with a building permit? yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters i Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion of thefollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires pla No.of Cell: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- Ej o.o merg rnd. Battery Unitsency ig tmg rnd. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No,of Detection and No.of Ranges No.of Air Cond. To Initiating Devices Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ................'" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection El Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of No.of Devices or Equivalent , Heaters No.of Data Wiring: SIS Ballasts No.of Devices or E uivalent 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: 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 Lly BOND ❑ OTHER ❑ (Specify:) I cert,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: �G ?� cZ.�Cpl 'UG LIC.NO.: Licensee: — � y Signature (If applicable, ter "exempt"in the license number line.) LIC.NO. Address: c� �jG�c L(� � Sp I�y�.� N1ib 03 d Qj Bus.Tel.No.: fnCi3 �^a R t 9 t'1 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tec.NoJ-) '�a3 t L o� 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. $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL Y.ROUGH INSPECTION: Passed—[ ] Failed—[ ] Re-inspection requirecT($50.00)-[ j Inspectors'comments: (Inspectors'Signature-no initials) . Date 2.FINAL INSPECTION, Passed—[ I Failed—[ .] Re-inspection required($50.00) Inspectors'comments: (InspectorsSignature-no initials) Date 3•UNDER,GROUND INSPECTION: Passed—[ j Failed—[ j Re-inspection required($50.00) Inspectors'comments: (Inspectors}Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ j Failed—[ j Re-inspection required($50.00) Inspectors'comments: (Inspectors'Signature-no initials) Date a 5.INSPECTION-OTHER: Passed—[ ] Failed—[ j Re-inspection required($50.00) Inspectors' comments: (Laspectors'Signature-no initials) Date D OOR TAGS ARE TO BE FILLED OUT AND LEFT ON SM IF THE AREA TO BE INSPECTED ISNOT ACCESSIBLE AND A.RE-INSPECTION OF$50.00 IS TO 13 CHARGED. 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): ' � G)'L� c�1 Q_4 2, 6-,,)l ��� � C_ Address: I i L-1��\. �� o City/State/Zip: `w1 /1Aa 3�7g Phone#:_ Are ou an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sb%et.1 7• ❑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. ❑ We are a corporation and its required.] officers have'exercised their I O..XElectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � ��` ��4�S Policy#or Self-ins.Lie.#: Expiration Date: l 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 cer ' der,t Z"d enalties of perjury that the information provided above is true and correct. Si nature: Date: Phone 9: � ��/� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Gomrnonwealth 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 Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia Date.. /Sll z. .. . ... .. pORT1y OjOya4..ao ,e,4,0 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION .. �'ISS ACHUSE� •# This certifies that . .75!�?.ll���s'. . . . . . . . . . . . . . ... . . . . . . . { has permission for gas installation .� �!n. . 7 . . .. . .. . . . in the buildings of//. . . . . . .1.9.n?a.!`�:r! . . . . . . . . . . . . . . . . . . . . . at . . . .�. North Andover, Mass Fee. .�lr. ���J Lic. No.. 'f! ?. . chi.- !. h. � GAS INSPECTOR Check# Zo 510 8'178 •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I CITY a MA DATEloe PERMIT# JOBSITE ADDRESS _ OWNER'S NAME111-vin ':rA �►,p, �_ GOWNER ADDRESS TEL 6 � ,f�� FAX[ TYPE OR OCCUPANCY TYPE COMMERCIAL -I EDUCATIONAL PST © RESIDENTIAL CLEARLY NEW:E_1 RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES Q NO APPLIANCES 7 FLOORS- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -J �--1 I _ I I L:::]_1=1 [ BOOSTER CONVERSION BURNER COOK STOVE I T�1 _ - _1 _ r-1 .. ..... .. .. DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE -- INFRARED HEATER LABORATORY COCKS (_ ( ^ - I ( _=-I _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNITI TEST UNIT HEATER I� UNVENTED ROOM HEATER hf WATER HEATER — I . —1 --I _ .� � i ! _.T.._i - OTHER INSURANCE COVERAGE__ - 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES eN ED IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ®( BOND F 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 [j AGENT �]( SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ,-� - _— LICENSE# SIGNATUR MP GF D JP 0 JGF Q LPGI CORPORATION[t# p PARTNERSHIP 0#=LLC[_jj# COMPANY NAME. ADDRESS CITY STATE®ZIP (D 3 . TEL FAX CELL _ _ EMAIL _ `� Jew ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ] FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth ofmassachusetts Department of Industrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): - - Address: City/State/Zip:,fT, , It hone Md ✓3779 -37Z- - A re yo an employer?Check the appropriate box; am a employer with 4. ❑ I am a general contractor andType of project(required): I6• New construction employees(full and/or part-time).*' have hired the sub-contractors❑ I am a sole proprietor or partner- listed on the attached sheet [7. ❑Remodeling ship and have no employees These the have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. [No workers'comp.insurance 5• El We are a corporation and its g' [J Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.E3.1 am a homeowner doing all work right of exemption per MGL 11. Plumbing repairs or additions myself.[No workers'comp. C. 152,§1(4),and we have no 12,❑Roof repairs insurance required]t employees. [No workers' comp.insurance required.] 13.❑Other "�-LY a~H-1caul-th-t coed✓s box Yj L++L'£t also 1111 OLt the£ecCion below`-owing'-- ^eu coo�: 'e�WY�saE4cnpoi,;c;iafo� fioa. t Homeowners who submit this affidavit indicating they are doin=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- Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach it copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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 pains and penalties ofperjurY that the information provided above is true and correct. Sien Date- 4 e2 Z. Phone#- F[6- 0ther only. Da not write in this area,to be completed by city or town offzciaL n: PermitUcense# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical(inspector S.plumbing Inspector son: 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 6r 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" another_who.employs persons to-do-maintenance,.construction or-repair-work-on-such dwelling-house-. --- - —.-.or on the grounds 6r building appurtenant thereto shall not because of such employment be.deemed to be an employer." MGL chapter 152;§15C(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 coxnpliance 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 certificates)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 1. 't that,'w 7. t 'L r ran` Y c ei n requested, t ' a e 4 13e.rets=Tae,: to the�3E�'Gr t+�G��i tit=�t-ser FyUi-JJ-4GaLiOn for- L::e p o:�4 C1_�_�-3 1_•br•t?�r_q.1�sw�,�S2 tfl��_pZr[:T_Tt„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/lice'nse number which will be-used as a reference number. In addition,an applicant that must submit multiple permit/license applications m 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 f6r 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 Of,,ce of lurestiigat ons 600 Washington Street Boston,MA 021.11 Tel. #617-727-4900 ext 406 or 1-8.77 MAS-SAFE Revised 5-26-05 Fax#6.17-727-7749 ColumUfa Gas- of Massa- husetts A NiSource Company 55 Marston Street ILE 1 COPY P.O. Box 869 r Lawrence, MA 01841-2312 June 5,2012 978.687.1105 Fax:978.688.1875 .Jessica Tamariil Account Number: 479 Stevens St North Andover MA 0 1845-3 001 Dear-Jessica Tamarin: During a recent visit, our service technician detected a safety problem with your gas house piping located at 479 Stevens St.,North Andover,MA. Accordingly,we have issued a Warning Tag because of this situation. Found small fuzz leak on main line of customer piping. Under the circumstances, we strongly urge you to correct the code violation. In addition, the Massachusetts code pertaining to the installation of gas appliances and gas piping, established under Chapter 737,Acts of 1960,requires that the condition be remedied. If you have any questions, please call our Service Department at 1-800-698-0940 and ask to speak with the Service Supervisor. Please disregard this notice if the condition has been corrected. Sincerely, Customer Service Department Columbia Gas of Massachusetts CRR: CRR# CAcisupdatedletters1110 06/05/12 ,aORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING C •D•�T�D��"A' t �,SSACNUS� ` This certifies that 10. . ................. has permission to perform-, .. ................................................. wiring in the building of., ............................................... ... .....................North Andover,Mass. Fee Lic.No. .... ELE C PECTOR } Check # 7466 d r Official Use Only Convnonwaalth a��asdatieWa� �] Permit No. 14140 LEW _!)¢ arf`men o1Jir¢_3arvic¢i �J P Occupancy and Fee Checkedi BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORIN ELECTRICAL WORK . All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CM00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6(� City or Town of: A)&/L7-4 4 Jbot/to/1 , 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:)_41 1 q S i e LjeA S j. Owner or Tenant �}��`�_�` pfr [ a AmDn 3 Telephone No. (0— 3" W l Owner's Address arrn'P-- Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts . Overhead ❑ Undgrd❑ No.of Meters New Service Ampf / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Se-Cur t o," PIM t..•at'r.-) S�5-rem Completion of the followingtable may be waived by the Ins ector of Wires. o.of I ota jl No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA ,t No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above n- o.of bmergency Lighting No.of Luminaires Swimming Pool drnd. arnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones o.of Detection an No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons b Heat Self-Contained n No.of Waste Disposers Totals: - um er ons Detection/Alerting '—--""-�--"' ''-- ection/Alertin Devices ' unicipal No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Jrquivalent No.o aterKW o.o o.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent e ecommunicationsWiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: i 7—01 1 f(( Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value ofIe trica ork: • ` (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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE N BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete.' FIRM NAME: �T Se_Gur1: LIC.NO.: Licensee: .c [-ts Signatur LIC.NO.:/ Z (IfopplicabAeen_te�r "exempt"in the license numlZer line.) Bus.Tel.No.: S9d Address: / 9 I? L!>UTC�1 �� ��cS 'UH �3a�9 AIL 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/AgentPERMIT FEE: $ dV O O Signature Telephone No. COMMONWEALTH't�F ►i11�:,SA��fi���`;'�, � 1.I:C Ti. 1 14NS f ARTHUR W PIERCE 1 UPHAM ST SALEM MA G 5-2816 1y� 1324 V 07/31/07 D;ry 12 i r ` /fl! 'Ir1UIli1I!!1i•��?ru(�Y• �G.,•1tO0J?�ftrk;Flid�, DEPARTMENT OF PUBLIC SAFE , Llmise: SEC SYS CERT,CLEARANCE Aq Number. SS CC 00051.7 • '�•:i :� aiRr.detc: 3BJ3011E4� Pap►reD; GB/�WZOCB Tr.no: 87.0 Restricted: 00 AN i NUR V'f PIERCE 1 UDNAM ST � _ SALEM f,jCom rnns% 018?0 _ :-3 i sloner v d � � Zd WcIj.9O LOOZ £0 889S17L SL6 'ON XdJ SDdB I d 188 WOd Date... :...n ...... i f NORTH, ° <"'° '• "° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� f ?� Thiscertifies that ........ ............................................................................. has permission toperform .....:,J.r. �. i........ ...................... wiringin the building of. ................................................................................. at...y%..` �-.. ....."' .............. .North Andover,Mass. ........... .. .... Fee42.6..... ... Lic.Noh.-Y.270(. .....7� IV ' '1 .�-,� LECTRCAL INSPE R { Check # / G 7499 v.....•v.•��VM.Y11 v• •-�MVJMVIIMJ�r�.I„7 -Permit No. //�f--,--� a ¢ /4f 9 Department of Fire Services _�_1, Occupancy and Fee Checked p r` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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: 7- 3 - ()-7 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) �I Z J Owner or Tenant -7FSS,GA TAM 4A id Telephone No. 978-(o$S-gq/18 Owner's Address 5-Awiet ft Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of BuildingT_ �' C'4 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: Xle N� ,t'GrJ itJf ca q✓tog�t,� Completion of the following table ma be waived by the 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 ❑ In- E] No.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etecn InitiatingDevices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat um umber ToK No.ofSelf-Contained Totals ns Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ un�cipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No. o 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- Q00.LV (When required by municipal policy.) Work to Start: _ dy 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 age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) certify,under the pains and penaltieso perjury,that the information on this application is true and complete FIRM NAME: alC*4G LIC. NO.: (o 7 Licensee: ',A-6htJ Off 6fr;4tJ Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel. No. te03 8 Address: 2 %��v�C/s�n,i�/ ,ai2 , S.a/fes /Ufa d ��7g Alt.Tel. No.:lo0.3- SS6-t3.c6 *Per M.G.L c. 147,s. 57-61, security work requires Department of Public Safety "S" icense: Lic.No. OWNER'S INSURANCE WAIVER: 1 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ !� j Location Z2�2'7 ✓G -� _� /'.ms's No. � Date NO 0 TOWN OF NORTH ANDOVER � O AL Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ sACHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # ( 3 53 "U ilding Inspe r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: �� � M ic SIGNATURE: Building Commissioner/inspector of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: �� 1.2 Assessors Map and Parcel Number: 471 q �5�v-e� S . ND -n U L) Map Number Parcel umber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided c 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print) Address for Service: ` e Signature Telephone 2.2 Owner of Record: Name P t Address for Service: z r hAA rn Si nature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable lir Licensed Construction Supervisor: License Number r Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r Z Expiration Date G) Signature Telephone V I SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ L Wting Boding ❑ Repair(s) ❑ T��terations(s Q. Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: a R� vin SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be "01TICIA ,USE ONLY Completed bypennit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 60 0 . U 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, !J as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, all matters relative to work authorized b this building permit application. Sin ftura oe oe Owner Date Jt SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief / Print Nat Signature of Owner/A ent Date NO.OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isr2ND 3RD SPAN r DIMENSIONS OF SILLS DIMENSIONS OF POSTS DR�MNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHM/INEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-954 DEBRIS DISPOSAL FORM in accordance with the provision of MGL c 40 S 54, a condition of Building Permi Number is that the debris resulting from this work shall be t disposed of iri a properly licensed solid.waste disposal facility as defined b c 11, S 150A. y MGL The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from tF a Town of North Andover must be obtained for { this project through the Office of the Building Inspector ". Town of North Andover ": Building Department p 27 Charles-Street . North Andover, MA. 01845 6.. D. Robert Nicetta Building Commissioner. (978) 688-9545 = 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE JOB LOCATION 17 I ✓' ��Z Number Street Address Map/lot -HOMEOWNER Name. Home Phone Work Phone PRESENT MAILING ADDRESS NO. 04/tjLj4 City Town State ._Tip Code The current exemption for"homeowners"was extended to include.owner-occupied:dwellings of two units or.less and to allow such homeowners to.engage an individualfior hire.who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNFJR Persons)who owns a parcel of land on which he/she resides or intendsto.reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm stnxtures. A person who constructs more than one home in a two-year period shall not be-considered a homeowner. The undersigned*homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes,bylaws, rules and regulations. The undersigned"homeowner"certfies that he/she understands the Town of No.Andover Building Department minimurri inspection procedures and requirements and that he/she will comply with said procedures and requirem ts. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL T0VM of1.. 4 over *10 ndower, Mass., COCHICHEWICK RATED BOARD OF HEALTH Food/Kitchen PER. IT T D Septic System THIS CERTIFIES THAT.... .. ......... ;100 0 4 BUILDING INSPECTOR ;rwofiwooO ......................... .................................... Foundation has permission to ere ....00.110.................... Rough .... ... ............ erect ......... buildings on ... _j- -!A- Chimney to be occupied a A# ....................................................................................... provided that theperson ac mg this permit shall very respect conform to the terms of the application on file in Final this office, and to the proviOns of the Codes and -Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMITEXPIRES IN 6 MONTHS Final UNLESS CONSTRU ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.