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HomeMy WebLinkAboutMiscellaneous - 522 MAIN STREET 4/30/2018 522 MAIN STREET 210/071.0-0044-0000.0 / i F / Date.......h.......... ... .. - fAORTPI TOWN OF NORTH ANDOVER PERMIT FOR WIRING s'�CHUS� F This certifies that .......... A. �...�lt:..........l�/e ..... ............ has permission to perform ........pl ..K'0.r.%z: ........... .:...................�,r .�.�..K wiring in the building of......... ..........�..y.�'..'.,�........-IF ............................. at .............f::Z . ...,:!.4. .. L...............................................,North Andover,Mass. Fee... .. .. `....Lic.N4../r Z-......Il:.�r.�......�.........�....... .. �u .,J ELECTRICAL INSPECTOR Check# Commonwealth of Massachusetts Official Use Only Permit No. 2 y/ 2 _ Department of Fire Services Occupancy and Fee Checked ` a BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK hAll work to be performed in accordance with the Massachusetts Electrical Code(MEC)"527 CMR 12.00 INT (PLEASE PRININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspect 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 I o,�(,i t t•1 i l_t L i Sr-, Telephone No. X123._ 3F Owner's Address WA-)n sn Is this permit in conjunction Z-06 , a building permit? Yes ❑ No b[� (Check Appropriate Box) c l Purpose of Building g Utility Authorization No. Existing Service Amps VA /Z 4 6 Volts Overhead® Undgrd❑ No.of Meters New Servic JbQ Amps 41 / 4Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ta ge r A�.Q 0 6 % Completion of thefollowing table mAY be walved#v 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 Above In- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. El Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burgers No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: " ' '"' '""''' ............"'"' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW 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 Wires. Estimated Value of lectrical Work: , t (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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:) X certify,under thepains and Id ofperjury that tl: information on this app cation is true and complete FIRM NAME: . MM® L (� LIC.NO.: Licensee: tolA Signatu LIC.NO.: (If applicable,enter "exempt"in the license numb r line 9 Bus.Tel.No.- Address: 22 e I'j a 111 3 Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department 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. 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 Chanter 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 Ins ection Passe' Failed IN Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVIC SPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: iv kJ 401 Date: PARTIAL ROUGH INSPECTI N: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed ' Re-Inspection Required($.)❑ Inspectors Comments: I Inspectors Signature: Date: 'INAL INS ION: Pass Failed Re-Inspection Required($.) ❑ nspectors Comments: I I Inspectors Signature: a Date: —� :B WEINHOLD ...TOWN OF MER IMAC,MA. .......dweinhold@townofinerrimac.com ry The Commonwealth of Massachusetts - Department of InclustrialAccidlents Office oflnvestigations 600 Washington Street .Boston,MA.02111 -www.mass.govIdla Workers' Compensation Iassurance Affidavit:Builders/Cont°aciors/ElectrXcians/Pirimbers Applicant- ormation Please Print LegibXv Name(Businessiorganizationffndividual): " 1 t r C1 ��pC_ c Address: City/State/Zip: u f- MA Phone q A e�am u an eanployer?Checle the appropriate box: Type of project(required): 1, a employer with 4. ❑I a.m.a general contractor and I 6. [�New constructionmployees(full and/or part-time). have hiredthe sub-contractors 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 caworkers'comp.insurance. y,pBuilding addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised.their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbingrepairs or additions myself.[Eo workers'comp. c.152,§1(4),andwehaveno 12.❑Roofrepairs msurance r e 'ed. employees.[No workers' comp.insurance required.] 13F]Other xAny applicant that:checks box#1 must also fill out the section below showing their workers'compensationpolicy information. 'Homeowners who sabmit This affidavit indicatingthey a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must attached an gdditional sheet showingthe name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workers'compensation insurance for my employees Below is the policy andlob site information. Insurance Company Name: Policy#or Self ins.Lic.#: ExpirationDate: .16 '2� Job Site Address: City/State/zip: Attach,a copy of t ie workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o.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 i a the form of a STOR WORK ORDER.and a fine ofup to$250.00 a day against the violat Be advise at a copy of this statement may be forwarded to the Office of Investigations ofthe AIA.for insur e verage v kation. X do Isere cerci r pe s ofperj t the information provided abo is ue and correct. - SignatureDate; Phone#: Official use only. Do not write in this area,to be completed by city or tort 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 InstrnctioN 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 ofhixo,• express o:rimplied,oral or written." .An employee is defined as"an individual,partnership,association,corporation or other lea e ti •,. � � l n or an two or more g �Y, . of e Y the foxegomg engaged in a j oint enterprise,and including the legal representatives of a deceased em to ex or the P Y ,, 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 employes." 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 notproduced-acceptable evidence of compliance ance with the insurance e 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)andphonenumber(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 LL C or LLP does have employees,a policy is required. Be advised that thisaffidavit maybe.submitted tothe Department of Industrial Accidents for confirmation 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 ermit or license is beim requested,p g sted not the De artme t � � p n of Industrial Accidents. Should you have any questions regarding the law or if . q g g you axere uiredto obtain a •�o Y q w iters 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 thatmust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessaxy)and under"fob Site Address"the applicant should write"all locations is (city or tow:n):'.A:copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for futureh or ernuts licenses.uses. Anew affidavit must be filled out each year.Where a home owner or citizen zen is obtaining a license or permit not related to an business or commercial e . Y al v nture (i.e,a dog license orpermit 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 GQxr on-weam ofmassarl vmtts Doparbent QVIldwWal,A,coldants Office ofIn,Vestzgat't4us 69Q WashiVw freet Boston,MA,021 It _ �'e.�,#��.`����'��4•.�QQ est 4qf ox X-•����11�.��.�.�� _ Revised 5-26-05 Fax 0 617-727-7749 WWW.Mus,gov/dia e7 Date. ... . . . .. . .. .. ...... .. kORTH Of TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION SS CHUS This certifies that . . .7�-,,-- '--I. .// . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee'. . . . . . . . . Lic. . . . . . . . . . . . /11� GASINSPECTOR Check 6464 MASSACHUSETTS UNWORM APK ICATON FOR PERMiT'TO DO GAS FITTING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date L�!_ 0 Building Locations �2 Permit# 1 Amount 3� �IH'1 Owner's Name L°U 1S �i`I i�U� r" S{^D New❑ Renovation Re ement L Plans Submitted EdrA t� U Z fY vi Z ZW e � t a O w Z F W W W V d a w �" F y C Q W w v, � Q x x `� Z a C O � w Z d w F Z F W W C7 O �> t: w U x w �. 5 p W C p, rn m Z vFi SUB-BASEM ENT x 3 0 U z > c a F o BASEM ENT 1ST. FLOOR 2N D . FLOG R . 3RD . FLOOR 4TH . FLO OR 5TH . FLOOR 6TH . FLOOR �, 7TH . FLOOR �, STH . FLOOR (Print or type) / Name &Z1W'1',) GG Check one: Certificate installing Company Corp. Address f m 4 ❑ Partner. Business Telep iune ® Firm/Co. Name of Licensed Plumber�or Gas Fitter / i � I INSURANCE COVERAGE Check ne: I have a current liability Insurance,policy or it's substantial equivalent. Yes If you have checked es please indicate the type coverage by checking the appropriate box. No� Liability insurance policy P1Other type of indemnity Bond 13 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: Signature of Owner or Owner's Agent Owner 13 Agent D hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S as ode Ch ter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber L City/Towrr, Gas Fitter icense Number ® Master _ APPROVED(OFFICE USE ONLY) Joumeyman D { 7� f�1 � Location No. Date MOR*� TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ rig°',^°•''tom Foundation Permit Fee $ Ss�cMusE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ � wilding Inspector 1 0, 464 10/24/96 10:52 30.00 PAID } Div. Public Works i PEIUVIT NO- APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP :DATE :PAGE ZONE I SUB DIV. LOT NO. F 1BOOK LOCATE �r- -v, S� PURPOSE OF BUILDING OWNER'S NAME � �— NO. OF STORIES SIZE[i4 �oy ��iti/ v �S' v OWNER'S ADDRESS �-�a �A�ls `"� BASEMENT OR SLAB ARCHITECT'S NAME �- /i r / SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME jA�✓ /�//��/! / SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW O' SIZE OF FOOTING X IS BUILDING ADDITION . MATERIAL OF CHIMNEY IS BUILDING ALTERATION ' 4�_� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF:CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EBT. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /DA FILED G d BUILDING INSPECTOR 81 ATUR ; F OW OR AUTHORIZED AGENT F E E ..z �-� OWNER TEL.# PERMIT GRANTED CONTR.TEL.# �9 CONTR.LIC.# H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY RIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY O s LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B I _I3 CONCRETE BL X PINE BRICKOR ONE HARDW D PIERS PLAS _ DRf WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1A TTIC AREA _ N_O B FIRE PLACES _ HE ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE _ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D ASBESTOS SIDKG COMMON _ VERT. SIQKG ASPH.TI STUCC ON MASONRY _ STU O ON FRAME BR( N MASONRY ATTIC STRS. d FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRI STONE ON FRAME _ ADEQUATE I� NONE 5 ROOF PLUMBING GABLE I HIP BATH 3 FIX. GAMBRELAMANSARD TOILET RM. 12 FIX. FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES 'KITCHEN SHTK SLATE NOPL BING _ TAR & GRAVEL STA SHOWER _ ROLL ROOFING Mp ERN FIXTURES TIIE FLOOR TILE DADO 6 . FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COW— _ STEAM STEEL BMS. OLS. _ HOT W'T'R O POR WCIOD�TERS _ AIR CO ZONING RADI T H'T'G U HEATERS 7 NO. OF ROOMS AS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING 1 _ JU aEpARTpiENT- DE Pt3BLIC SAFETY Oi tQ T PLACE �ONEA �� 1f184 - CONSTRUCTION SUPE.RVZ. 3ENSE� - Number= Expxres CS 058622 03AVb ell '38 .; ..». Restricted o 1G ch -b®ttbm fold s�gti. on JAMES W" SNT JR , . _;and ;l.aminat� l icese. card Za CUX11ANE ep t:gip for receipt an chan9 MET ft'EN, t1A. 01M boo f addrose not�ficat�an tip Z 77 i 1 Wwzwk- N aHOW - r I�fSdtAsxaW to In I a � h CDflSTRCTfiB�S DfkVSDQ;CICENSE UD one Ezpares, Birthdate i ��sonry.only '' t`�113/15li99B 03/15/19556 1 5 z Faint Notes t h ��.T~azlere t� passes a:.cprrent'editaRa of the dBas ��huseit& State:eu3ldipg,code YNIGNT lR i� cause for rauocatiao of this license I CDIt LANE I NETHUEIi, HA 4!844Von -its TWA, J. xnn Out,WHY Tow:,.. - fi ` r •'l _ . ___._ ._ --_ .� _ �:Fi.� ��y � -- — ���av�r-._ _ -_ -_ _ -.�.q•:_LLML-t'r".'l,:Lrs+z`.:iijw "oFFtCFS OF: _. R=. _,. �TowI1 Of -._ _r=`T�__ �.1 z6 n�aln sweet . -. — ._ ... _,j. _. "_North Andover. --._ APQE.�s .� ,y, =NORTH ANDOVER Massachusens o ts.s_ BUILDING CONSERVATION DMISSON OF _ HEALTH - - P"NNING PLANNING & COMMUNITY DEVELOPMENT _ KAR.E- H.P-`EL.SON.DIRECTOR In acccr:rrce wit,: the rrc�sic_z .. ami.. t S =�. a cor•,dit:en of Building Permit Number s thct :re dc...a resulting -rcm this work s.':cll be disrosed of in a rope: ..,rte;: s.;lid ;rs:. ^^sc. :rc:i :.s "c-Inc:! by .%tGi_ c il:. S ire dears will be dtsnose.. _. .... tcr..:t:::e i Pc::ntt �colicnc Date NIOT=: Demolition permit fr= the Town of :forth Andover must be obtained for this project through the Office of the Building Zaspector.