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HomeMy WebLinkAboutMiscellaneous - 56 CRICKET LANE 4/30/2018 (2) 56 CRICKET LANE 210/107.A-0215-0000.0 1 I 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,they ennit 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.01 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.invalidaf 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: ' ZZ Note:Reapply for new permit j ❑Permit Extension Act—Permit/Date Closed: Date...`.............................. NORTM 3?°•_��``°-.' "�� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACHUS� This certifies that � has permission to perform ...... —t .: .....:...: :.... .: : '.................. wiring in the building of........x ; 'r .e ./f.-.......................................... at..45................................................... ,North Andover,Mass. ! Fee.(............ Lic.NO.`"`39J 6.............., 4...... 1.ECTRICAL INSPE R ' Check # 934 Commonwealth of Massachusetts official use on�Y Department of Fire Services Permit No. ,3�% lug BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �'' [Rev. 1/07] APPLICATION FOR PERMIT T Qeaveblank All work to be performed in accordance with the PERtschusetts Electrical ORMCode(MECELECT 7 I AL WORK (PLEASE PRINT W BX OR TYPE ALL INFOR111ATIOA9 Date: ) vl2.00 City or Town of: NORTH ANDOVER By this application the undersigned gives notice of his or her inten 'on to perform the To the eic electrical work described below. Location (Street&Number) 15-4 Cr.i C �,intent L Owner or Tenant I K 4 C Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No LJ (Check Appropriate Box) Purpose of Building Utility thorization No. Existing Service Z� Amps_ !Z� / z�1JVolts �� Overhead �J Undgrd❑ No.of New Service Meters f Amps / Volts Overhead❑ rd Und --� Number of Feeders and Ampacity g ❑ No of Meters Location and Nature of Proposed Electrical Work: w.•v {c l(.-C(yt Com letion o theollowin table maybe waived by theIns ector of Wires. No.of Recessed Luminaires No.of CeiL-Sus No,of p.(Paddle)Fans Transformers Total No,of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires �13 Swimming Pool Above ❑ la o.o mergency d• ad. ❑ Batt e Units g —. No.of Receptacle Outlets 41 No.of Oil Burners . . F1RE ALAWVIS No.of Zones No.of Switches © No.of Gas Burners o..o Detection and No.of RangesInitiatin Devices No.of Air Cond. °� To No.of Waste Disposers eat ump Number T ns ns No.of Alerting Devices Totals• — -- o.of elf-Contained No.of Dishwashers Detection/Ale Devices j Space/Area Heating KW Local Municipal No.of Dryers g�� A ❑ Connection ❑ Other Heating Appliances Security Systems: No.of Water No.of No,of Devices or E uivalent Heaters lKW No.of Data W' Si s Ballasts . wing: 1 No.Hydromassage Bathtubs No.of Devices or Equivalent g No.of MotorsTotal Hp Telecommunications Wiring; OTHER No.of Devices or E uivalent Estimated Value ofE)6ctrj6al Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start G Q (When required by municipal policy) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE GE: 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 . undersigned certifies that such cove a is in force,and has exhibi d prroof of same to thverae permit issuing offe or its substantial ice. The CHECK ONE: INSURANCE BOND ❑ OAR g e. I certify, under th ains and ❑ (Specify:) p ties of perju ,that the information on this application is true and complete. FIRM NAME; ((v s �L Licensee: j (.9 o � LIC.NO.: Signature �i� •� � of applicable, enter' riot"in the lic ns LIC.NO.: -6 Address: �' C 1 ST- Bus.� *Per M.G.L c. 147,s. 57-61,security work requires D Bim•Tel. eq apartment of Public Safety S License: Alt Tel.No.:97�77y/�6f�Y OWNER'S INSURANCE W,��R; I am aware that the Licensee does not havethe liability Lic.No. required by law. By my signature below,I hereby waive this requirement. I am the check one ❑urance coverage normally Owner/Agent ) owner owners aQcrent. ❑ Signature Telephone No. FE�I7'FEE:,� D �yw o�c yip-�o //i� � � Y The Com►nonwea k of Massachusetts' k� Department of Industrial Accidents Office of investigations 600 If'ashingion Street ��Ir Boston,, MA 02111 Workers' Compensation Insurance Affitia Bailders/Coatractors/Ele ' A ;Leant Information ctrifcaans/P{ambers / Please Print LeQibl Nana(Business/Orgmizafion/Individual)'_ -GI u( ( �ILoC 't L Address: City/State/Zip:-r �.c:y e��r O/�1�� Phone#: . 7re : employer?Check-the appropriate box: employer with I 4. F7. of prep(required): ees(full and/or * ❑ I am a general contractor and I j.1ew construction part-time). have hired the sub-contractors. I am.a.sole proprietor or partner. Iisted on the attached sheet i Remodel' sh' g and have no ern These std-contractors have 8. Q Demolition working for me in any capacity. workers' comp.insurance. [No workers,comp.insurance 5. ❑ We are a corporation and its 9• ❑Building addition required-] officers have exercised their 10.0.Electrical repairs or additions 3.Q I am a homeowner doing all work right of exemption per MGL 11. Piumbin rgyseIf. [No workers comp. c. 15 ❑ g repairs or additions insurance.required 't 2, §L(4),'and we have no 12.0 Roofrcpairs j •emP{oYees. [No workers' COMP. insuranc e:required-j 1317 OthLr "Any applicant shat checks ba#l must also fin out the section below showing their workers'oom t Homeowners who submit this affidavit indicating th pensation policy information. ars doing �'—u ctors that check this box must g °i gall work eyed then hire outside contractors must submit a new affidavit indi attached an additional sheet showing•ties mune of the sub. S Such. cotrttzcftrs c a F�; �' f am an employer thatp is: m ' "u+'•Policy inibrmation. >adtng:workers,Compensation insurance formy.e ,w information. n PloYeet: !clow is,the policy mid job site Insurance Company Name: �c/ C G�r Policy 4 or Self-ins. Lie. Expiration Date: Job Site Address: d-Ll' City/Stat rzip: Attach a copy of the workers'compensation policy declaration page(showing the po;icy number and expiration date). Failure to secure coverage as required under Section 25A of MGL C. I52 can Lead to the imposition erof criminal fine up to $1;500.00 andlor one-year imprisonment,as well as civil penalties in the form imof a STOP WORK ORDER of a, of up to$250.00 a day against the violator. Be advised drat a copy of this statement may be forwarded to the Office of a fine Investigations of the DIA for insurance coverage verification. I do hereby certify der the pains a penfPerjrcry that the in ormatdon rov' f p ided above ` and Correa Si lure: Date: • l/� Phone#: 2 Ofj`rcial ase otfy. 13o not write in this area,to be completed by ck or town nciaL City or Town: # ' Issuing Authority(circle one): Permit/License 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Iuspector 5. Plumbin I 6.Other g nspector Contact Person: Phone#: Date. G. . . ,OR •1tic TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING lo ~ ,SSACMUSEt This certifies that . . . . .11!` c �'` �. . . . .../. . . . . . . . . . . . . . . . . . . has permission to perform . . . .. S. , . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . I �61��`� at . . .5. .` :. ., North Andover, Mass. Fee. 3 . . . .Lic. No..�1. !. .`.' . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # Z ? 85 " 2 00 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:/�/d rr6 A)Ow-a— .MA. Date: G /z-Zi<D Permit# 7 C Building.Location: .576 (,'e-sh_e7— C,v Owners Name: ���iii%v 1 r Type of Occupancy: Commercial❑ Educational❑ Industrial❑ institutional❑ Residential Q-- New:❑ Alteration: Renovation: Replacement:0 Plans Submitted: Yes No❑ FIXTURES DEDICATED z SYSTEMS Z u N � � ¢ V) � a � 5 E t7 arc rr z ac LU Q °G ? !a Z z S d w G ¢ z °C Z 2 W CJ d 0 Q 0 0 d Y Zr- a y 3 3 3 o c W �n 3 y Sue BSMT. BASEMENT 1 FLOOR / � FtAOR 3 FLOOR 4 FLOOR S FLOOR 6TH FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Or" J�!�M �i�.� � /� ��C ❑Corporation � ZZ Address: Z 'CLI!(1— CItWown:{ !_ State: ❑Partnership Business Tel: 61,R- ZZ-S77 Fax: E�,,Flm�� tSt/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a currentlab II insurance:policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes[-fl©❑ If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent El !hereby certify that ail of the details and information i have submitted(or entered)regarding this appal*don are true and accurate to the best of my Knowledgerand that all plumbing work and Installations performed under the permit Issued•for thk application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tide9 umber Si nature of Licensed Plumber City/Lown 21laster � APPROVED OFFICE USE ONL �Joumeyman License Number: Date..�� . / /(. .. . . .. RTM HO OF .0 -1 o� TOWN OF NORTH ANDOVER s so a PERMIT FOR GAS INSTALLATION � s a SACHUSEt This certifies that . . . .11. .1 .t, c�. . . . �,,t� . ./y . . . . . . . . . . . . . . . has permission for gas installation . . . . P.1,4 /.'/. �� c . . . . . . . . . in the buildings of . . . . . ,/? �.n Y . . . . . . . . . . . . . . . . . . . . . . . . at . . . .. . . . . . .. North Andover, Mass. Fee. . .). .� Lic. No../.) -V G4S INSPECTOR Check# 7 , 83 � z• s�v MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:_A/9y�� �oa,c>- , MA. Date: G I l� Permit# Q I 4L 3 Building Location: _56 C '/�jG� ji Z� Owners Name: Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional ❑ ResidentialET' New: ❑ Alteration.❑ Renovation: B'Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES UJ w rn Zv = m = O W W U fA F_�- O = ir W Z F-. Z J Z Q W le O W N Q O � W W O Q D fn V IL W UJ X Z y 0 O W y 0 I.W.. = ti z W W Z O J I— H O Z J 0 u. � = W I— W W U s oLL g 'o a° �° r > o SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR V—FLOOR T—FLOOR 7 FLOOR 8 FLOOR Installing Company Name: // Check One OnlyCertificate# ri�w , / G,h ,�� �-- ��,,��,,t,� ❑Corporation Address: ! ytrr J)q , City/Town: State: ❑Partnership Business Tel: 97k 6/fs- 7/.!5"-7 Fax: E�l,� l_`3'I-�rm/Company Name of Licensed Plumber/Gas Fitter: ! iv INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes Flo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liab9lity Insurance policy '-'� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owners Agent Owner E] Agent E] By checking this box(];I hereby certify that all of the details and information 1 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. By Type f License: P-Plumber Title ❑Gas Fitter �111_aster Signature of Licensed Plumber/Gas Fitter Cit ❑Journeyman License Number:-,z- Al— APPROVED OFFICE USE ONLY El LP Installer