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HomeMy WebLinkAboutMiscellaneous - 50 STANTON WAY 4/30/2018 l BUILDING FILE Date..1.4-4 ...1Aq........... r � poD ° ~� TOWN OF NORTH ANDOVER * * PERMIT FOR WIRING t BSACHUS� Thiscertifies that ......� ,. .. . ..0................................................. has permission to perform ....I. �. �'!. ..........���( Vl�'1�1/I-�---- ... . ............................... wiring in the building of. - ..... ............................................................................ .;tat ..-To.........-�..T..A.N..'.-oe......... .. .. ....... 04h Andover,Mass. 1 Fee 6..99...-.1.-..........Lic.No. .. .. �....V.. -....:................ I; :,...... . .. .... . ELECTRICAL INSPECTOR Check# J �� Commonwealth of Massachusetts Official Use O ly Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT)7V INK OR TYPE ALL INFORMATION) Date: 4)0/ City or Town of: NORTH ANDOVER To the Inspector o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant 2 t' Telephone No. 403 % Owner's Address p /'7 3� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building (( Utility Authorization N /(o O / /9 9 - Existing Service Amps Volts Overhead ElUndgrd[ No.of Meters New Service Amps / / O Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity �V ►f� 60'2� l b Location and Nature of Proposed Electrical Work: o Al � Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans ;1- TransTotal Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires O Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 7 No.of Oil Burners FIRE ALARMS. No. of Zones No.of Switches ,l Q No.of Gas Burners No.of Detection and 7 Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KWNo.of Self-Contained Totals: ' ' '"'""""""'''"'"" ........... "" Detection/Alerting Devices No.of Dishwashers f Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers f Heating Appliances Key Security Systems:* 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 Equivalent OTHER: uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Wor . (When required by municipal policy.) Work to Start: Inspealo_�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:) zcergy,under the pains and penalties o per ury,that the information on this application is true and complete. FIRM NAME: . t LIC.NO.: Licensee: Signature - LTC.NO.: /771 U11— (If applicable,enter "exempt"in the license number line) u Tel.No.: Address: A el.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 hal ow,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Ag l PERMIT FEE: $ Signature Telephone No.� d.3�7 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the +. permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: L Pass Failed 0 Re-Inspection Required($.)❑ M Inspectors Com ents: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: v Inspectors Signature: Date: FINAL INSPECTION: PassFailed Re-Inspection Required($.)❑ Inspectors Com ts: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com N� The Commonwealth of Massachusetts ' Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information i J © Please Print Lez:ibly Name(Business/Organization/individual): : L� Address: City/State/Zip: -��(, �� � C Phone#: (60� C9 4: ZZ Are you an employer?Check the appropriate b x:1 Type of project(required): 1.❑ I am a employer with 4. [:11 am a general contractor and I . 6. E]Now construction employees(full and/or part-time).* have hired the-sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees T�sub- actors have 8. ❑Demolition working for me in any capacity. wrance. 9. E]Building addition [No workers'comp.insurance 5. a are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 1❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] 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. 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:. (� Policy#or Self-ins.Lie.#: 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certo under the pains and pen i perjury that the information provided above is true and-orrect. - Simature: Date: 1 Phone#: 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#: Informati®n and Instructions ' M 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 employeiis 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 maybe 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 L dustrial Accidents Office of Innvestigations 6.00 Washin&a Street Boston,MA.02111 TeX.#617-727-4900 ext 406 or 1-877:MASSAlFB Revised 5-26-05 FaY,#61.7-727.7749 www.mass,govfciaia '.COMMONWEALTH OF MASSACHUSETTS BO D'OF E t(T.. ICI`ANS I SSUES THE FOLLOWING. L.I l;ENSE x: AS -A REG' JOURNEYMAN E:LECTRI C-I`AN MATTE HW K P I TK I N ; ° .yrs , `; ! I 137 BEE�E HILL ROAD \ FE:EMONT NH 03044-3202 1771,tR 2481 I , Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 434,000.00) m $ - $ 5,208.00 Plumbing Fee $ 651.00 Gas Fee 100 comm. $1 110;0(0;0) Electrical Fee $ 651.00 Total fees collected $ 6,610.00 50 Stanton WAY Lot 5 001-15 on 7/1/2015 New Home Date 5i ............ 10603 R o do TOWN OF NORTH ANDOVER 7C: PERMIT FOR PLUMBING This certifies that. J9... 2- ............................ /.......7.............................. ....... has permission to perform....... ............ .... ...... ... ..................................... buildings of..(---,n ..................................... plumbing in.the t ..... .......L....P...�.. . .......1:7........... North Andover, Mass. Fee Lic. No.,... .. ... 1......................................................................... PLUMBING INSPECTOR Check a4 � SII ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY NORTH ANDOVER , MA. DATE 8-12-14 PERMIT# )V JOBSITE ADDRESS 50 STANTON WAY OWNER'S NAME I GREEN AND COMPANY P OWNER ADDRESS: PO BOX 1297 N HAMPTON NH 03862 TEL: 8004298615 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑� PRINT CLEARLY NEW:❑■ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES 1 FLOORS Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 2 CROSS CONN DEVICE 2 DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY 4 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES 1 d- WATER PIPING 1 SPIGOTS 2 w INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑■ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWN 1 F1AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted(or entered)regarding this applicatio r tru/aur to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applic o ill b ' ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME: MIKE BURKE --71 LICENSE# 13127_ /L— /Z IGNATURE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRESS: PO B&896 CITY: PLAISTOW STATE: NH ZIP: 103865 FAX: 6033780040 TEL: 116033780020 CELL: 19784909385 EMAIL: J.LAURENCIO@POWERHOUSEPLUMBING.COM MASTER❑■ JOURNEYMAN❑ CORPORATION❑■ # 2482 __ PARTNERSHIP❑#F= LLC❑# 1 UGH PLUMBING INSPEJAION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION N6TES �Y Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES I Date..... ,?�. ................... tko 0 3a° " x TOWN OF NORTH ANDOVER f � 9 PERMIT FOR GAS INSTALLATION gB,CHUg� This certifies that .! - .`." "...... � '�' "0 ....... has permission for gass i�nsstallation �f'J Q... �'.-- in the buildings of..... E'.` - '..... .. ... ' ........................................................ at.................................................,Y.....................1r...�-:°�" , North Andover, Mass. Fee....................... Lic. No. .......................... ................................:.................................... GASINSPECTOR Check# tY 6 9471 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM"GAS FITTING WORK CITY I NORTH ANDOVER MA. DATE 8-12-14 PERMIT# JOBSITE ADDRESS 150 STANTON WAY OWNER'S NAME I GREEN AND COMPANY GOWNER ADDRESS: I PO BOX 1297 N HAMPTON NH03862 TEL: 800 429 8615 FAX:^ TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑■ PRINT CLEARLY NEW:❑■ RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES Z FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE :I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 9 NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application a e and a r to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applic ' n 'll be in m nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITTERLAAME: MIKE BURKE LICENSE# 13127 SIG TURE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDR S:LMOX 896 CITY: PLAISTOW STATE: NH ZIP: 03865_ FAX: 6033780040 -� TEL: 6033780020 CELL: 9784909385 EMAIL: J.LAURENCIO@POWERHOUSEPLUMBINGAND HEATING.COM MASTER 0 JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0# 2482 PARTNERSHIP❑#=LLC❑# it ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSJECTIONOTES Yes No Ste' J THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES -SURY ♦ � � _ AU OF SUILOINQ SAFETY S CONSTRUCTION € PLUMBING SAFETY SECTION -y i '+ ME, MICHAEUM BUR } ' 5 LL Y IC #-3801 M FIRES: 05/31/2015 /� Boa , '�• � ;. . k�• Sta of Nrnpshi _ r AiJ of tary He g chnic , s LTH ug rmiZ� . . � N E MICHAEL KEBOARD OFA ;Ta, »1 PL JHOER't AND T�GJ Ir ITT , N SEMS H IH DATE I 02118 @1 . :.; , IZEG t STER>:t1: AS , . 'LU)iB IG ,. e DATE ES: 02/2912 9 rriI� I_AEL4 W BURKE. {y �y f. 1 �owER_"OUSI; PL9y uI~IkI:A! !NVQ �Ct3R A ` f '�S1 CO�L�I S, H I LVrtRtj b e, {. Efl � J . 1YV 07l+f;_ /p 4y -yn' Y. C wFeatth of M huse"s a•.., ; •r ,� t cepa rr nt of p Iic S fey ,t R nrr feehn -,an (i. Iticale License: SU 2 CHAR W p ♦ e p 61 RLISS p^ R Her H MA it ♦^.. Expiration , 3StQ(3Qi OS/2016 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): POWERHOUSE PLUMBING CORP Address:PO BOX 896 City/State/Zip:PLAISTOW, NH 03865 Phone#:6033780020 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 6 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. M New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp. insurance.: ' 9. EJ Building addition required.] 5. ❑ We are a.corporation and its 10.❑Electrical repairs or additions 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' 13:0 Other comp. insurance required.] *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. :Contractors 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 is providing workers'compensation insurance for my employees. Below is tl:e policy and job site information. Insurance Company Name:HARTFORD UNDERWRITERS INSURANCE COMP Policy#or Self-ins.Lic. #:04WECIT2480 Expiration Date:7-28-15 Job Site Address: 50 STANTON WAY City/State/Zip:N ANDOVER MA Attach a copy of the workers' compensation pol' declaration page(showing the policy number and expiration date). Failure to secure coverage as required/Overa o 5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year i , 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 viovised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' s ancverification. I do hereby certify and lire ai and pe allies of perjury that lite information provided above is true and correct. Sip-nature: Date: /Z / Phone#: 603378 0 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#: