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Miscellaneous - 60 RALEIGH TAVERN LANE 4/30/2018
60 RALEIGH TAVERN LANE 210/107�g"0OW•0 1 L Date... � ................ HORr/� TOWN OF NORTH ANDOVER 031: -�: '• ooh "INV . a PERMIT FOR WIRING ss�c►�uss 62. Thiscertifies that ........................................................................................... .......�.............................. has permission to perform , '`' E ?°5 S SPC Viz. 1 �7 ....... .... .............................. .................... ......... wiring in the building of......... , at (0.0....... &. 42 '!A .......... .....`'" ...... ,Vorth Andover,Mass. Fee..... .. ........Lic.No. ............... .........,...... % �� i.. ELECTRICAL INSPECTOR Check# t Commonweal of Maaaachusetb Official Use Only 1I-ycc�� cc�� Permit No. aI-MMMM 2epartnwnt of im Seruicei Occupancy and Fee Checked )W- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 2.00 (PLEASE PRINT IN INK OR TYPF�A,LLL/INFORMATION) Date: City or Town of: � � 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) Owner or Tenant Telephone No. 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 ❑ Undgrd❑ No.of Meters 3 New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters 4— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,`f rb�--- J Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: (Paddle)Fans Sus . No.o Tota p ( Transformers KVA S / No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 1No.of Oil Burners FIRE ALARMS No.of Zones �- No—.of Detection and No.of Switches No.of Gas Burners Total Initiating Devices " No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW o.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection Heating Appliances Security Systems: No.of Dryers KW No.of Devices or Equivalent No.of Water No.of o.of Data Wiring: � Heaters KW Signs Ballasts No.of Devices or E uivalent Bathtubs No.of Motors Total HP Telecommunications firing: No.Hydromassage No.of Devices or E uivalent OTHER: d _ Attach additional detail if desired,or as required by the Inspector of Wires. A 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 COV RA E: 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. S CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:Sp,r 4 Inst I N, `1%,G. LIC.NO.: 4" < LicenseeA( 6� 6/ j 'J-e. w A4 y Signature .�-= —""� LIC.NO.: _ (If applicable, enter "exe) pt"int license n ember line. �s ) , .Tel.No.: Address: Alt.Tel.No.:qi I X.)3 V *Per M.G.L.c. 147,s. 57-61,security work requires Department of-Public 9afety"S"License: Lic.No. S/YS T 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 IPERMIT FEE: $ e Signature Telephone No. L CCU � � �rn ck. r � Y ° COMMO NWEALTH O ASS ETTS BOARD O ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN SPEEDWIRE INC CHRISTOPHER J TREMBLAY 57 HARRIS ST NORTH ADAMS MA 01247-2338 18365 A 07/31/16 36270 SS-001895 CHRISTOPHER J TREMBLAY 393 Jericho Tpk S6 Mineola NY 11501 05/24/2015 Date... qh.�.......... NOR7/l ?F. •.�` ;.',tico� TOWN OF NORTH ANDOVER c PERMIT FOR PLUMBING • i ,: + CHUs�t .. . This certifies that............�,trSi. ( ...... ......... .. ..................................................... has permission to perform... VAS. .... �u�. 'i.......... ....... <....................................... plumbingi he build`in4s of............................................................................................. at......�t.(?... !e,4 Vit.........I.��. .E?.....I-!U................ rth ndover, Mass. Fee.q.. A. . ...Lic. o. ..t?.vZ . ................. �. . ........................................ L ING INS CTOR Check# Z f T MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY MA DATE ( PERMIT# JOBSITE ADDRESS aI ,wr. OWNER'S NAME /IAr f C POWNER ADDRESS TEL ____ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: Fil RENOVATION391- REPLACEMENT:® PLANS SUBMITTED: YESE11 NO[--]! FIXTURES 7. FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ji_ -____ II_ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _ _i -_-- J ._.._..1 ___-__( ._.._—E I .__. _._r_J ._._.__I .....�E ..__..__( ..._.. __.( ._-.___E E ___.i FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN .E _j SHOWER STALL SERVICE/MOP SINK _ __I ._ ___!EDTOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _) I E I i 1 I f 1 WATER PIPING OTHER:� _ III_.._._._.IIL_ _-JIL __:J -._._..J -.....1 INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESNO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC' — OTHER TYPE OF INDEMNITY U( 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 ON ONLY- OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are a ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pli c ith all Pertinent provision of the 1Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ,ery. _ E LICENSE# 146a3 _ ( SIGNATURE Mo- JP 0 CORPORATION MJ#PARTNERSHIP Of LLC ED# j COMPANY NAME tars dcr (,th �S } .cF�► ; ADDRESS 0- Q CITY -- _...._.____)STATE /(1(-( 1 ZIP ( 'ST TEL d 3-��� s 07 — FAX _ CELL �T�`" '���. EMAIL - UGH PLUMBJNG INSPEJOTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTrON S Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES f ' c 1 The Commonwealth of Massachusetts F Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 �e www.mass.gov/dla Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/ lunnbers. TO BE FILED WITH THE pERM[TTING AUTHORITY. ..Please Print Le 'bl A •'licantlnformation in r niationIividl): STariO(Business/Org Address: 9.6• City/State/Zip: Phone If: Are you an employer?Check tlae appropriate box: Type of project(required); em ees frill and/or part-time)." 7. Q New'constriictlon 1. a employer with _ P to Y 2.0I am a sole proprietor or partnership and have no employees vVorking forme in $, emodeli ng any capacity.[No workers'comp.insurance required.] 9. Memolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 4 proprietors with no enipkyees. 12 Ll.Plurribing repairs or additions 5.0 I am a general contractor a1.nd Ihave hired the sub-contractors listed on the attached sheet. 13•.EjRbof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.[l Other 6.Q We are a corporatiori and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 zriust also fill outthe sectionbelow showing their workers'compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors that check this Box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providingworkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: - � a�C�..� �w^ � City/State/Zip: ��• ��•`� Job Site Address: Attach a copy of the Workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required ande�rM enalties?mthe form of25A is a aSTOPnal 1olation WORK ORDER.punishable nd a fine of up to $250.00 a by a Elie up to$1,500-00 and/or one-year imprisonment,as w p day against the violator.A copy of this statement may be,forwarded to the Office of Investigations of the DIA for insurance coverage veriftc tion. X do hereby c ti nder the pains and penalties of perjury tliat tlae information provid&_S� d above is true and correct. Date: Si ature: Phone#: _ — a °A official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# issuing Authority(circle one): i I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: y i 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 ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiv&4 trustee 6f 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 b6 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 reg4ted." 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 numbers)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 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"rob Site Address"the applicant should write•"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a 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 burst leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia ;. :GOMMONWEAI-0 OF ::ova • . r • t • gpARQ TERS S AND 'GASFiT PLUMBER L I r,ENSE THE FOLLOW..ING ISSUES<. STER<.PL:UMBR a PIERRE ... N. :. CORY J ST �r�� � / `W 1 9 EAST p1NE S t NH UG o3865.- ���: OW 2 1164 ,. COMMONWEALTH OF MNSSACHUSET'CS: PLUMBER;S`::AN SE, .; SSU; .:S;: <THE FOLLOW ```�..I.. > N: <Y MAN!pa<.U:M . .. Ir GFtX;; J ST P I ERRE V il. f U i - f t i 1 J i E P>I>,jjE ST . 9 - NH 03865- A p .. 3 2`:1:....:2`:.x:;, Y Date.... "- 1 ..... . f NORTI,, :;•_';�``°-{•�.."°0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING �sSCHUSE� Thiscertifies that ..... .............s........... ..................................................... has permission to perform ......... wiring in the building of............ l?..5..... .... ......................................... at.............. . .f U.. . .Z-'_-Vorth Andover,Mass. Fee..................... Lic.No.. . ',�S'.�.. / �! /l EYEcmicAL INSPECTOR Check # cif8 ��� Official Use Only (,orrcmortweaCth o/ C Permit No._ <,UePartrirunt o�Jire JeroicaQ VOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1107] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical-Code(ME ),527 CNIR 12.00 (PL.-ASE PRINT IN INK OR TYPE ALL IN/F kVLMOM Date: S c3v City or Town of: Aok a +-1'0JnUdN-' To the Inspecf r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street Owner or Tenant�� N—� �cn f� C,�ti� Telephone No. 4?&6� Owner's Address Is this permit in conjunction with a building permit?1\ Yes-�' No ❑ (Check Appropriate Bas) Purpose of Building�1� �,��C. V �T -tN\ 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: C t��►� M� �l Completion of the following table may be waived by the Inspector of Wires. No.ofNo.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transot Trformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting No.of Luminaires a ernd nd. Battery Units No.of Receptacle Outlets• No.of Oil Burners FIRE ALARMS No.of Zones. No.of Switches No.of Gas Burners No f Dete i Devices No.of Ranges No.of Air Coad. Ton and ons INo.of Alerting Devices No.of Waste Disposers Beat Pump Number ons V No.ofSelf-Contained P Totals:I I I Detection/Alertine Devices S ace/AreaHeatin KW Local ❑ Other No.of Dishwashers P g 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 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 X;_T BOND ❑ OTHER ❑ (Specify:) 1 certify,antler the pains andpenalties of perjury,that the information on this application is trite and complete. FIRM NAME: LIC.NO.: Licensee: Signatu e _ LIC.NO.: (If applicable,enterexempt"in the lice. number line.) Bus.Tel.No. Address: rh,,, ' tA, d3 SI 1 Alt.Tel.No.: *Per I.G.L.c. 117,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 1 am the(check one)❑owner ❑owners agent. Owner/Agent . Telephone No. PERMIT FEE: $ Signature 1 1� � � � I �� �,LLs���1 V" ` 1 �v'�� r- � {.. _. . �, z, Y v � .1' I •I PROFESSIONAL STRUCTURAL ENGINEERING DESIGN SERVICES P.O. BOX 958 E. HAMPSTEAD, NH 03826 (603) 329-5540 FAX (603) 329-6406 RESIDENTIAL• COMMERCIAL• INDUSTRIAL May 20,2008 Mr. Jack Mangini Dube Construction Plus Lewis Professional Building 10 Bricketts Mill Rd. Hampstead,NH 03841 RE: Client Requested On-site Inspection and Structural Evaluation of Observed Support Condition of Existing Second Level Main Support Recessed Beams Newly Installed at 60 Raleigh Tavern Rd., North Andover,MA Dear Jack As per your request,I have inspected and evaluated the above referenced Main Structural Support Beams recently installed at 60 Raleigh Tavern Road,North Andover,MA. As referenced in the attached Design Calculations,the existing Twin Gang Lam:2— 1 3/4"x 117/8" LVL Main Support Recessed Beams are adequate as constructed to meet the Applicable Design Criteria for Maximum Allowable Bending Stresses and Maximum Allowable Deflection. As evaluated,the notched beam end support conditions are adequate as constructed for the Applied Loading for Maximum Shear Transfer and Direct Bearing to the jack posts. As evaluated,the existing recessed Twin Gang Lam: 2— 13/4"x 117/8"LVL Beams,as constructed, meet the required design criteria for the required applied loading. Thank you, al r J. occia,P gis ed Structure P sident,Hamps MOCCIA Attachments STRUCTURAL H Na 33287 ISTER�� Fssl0NAI ��'\ OF S o'� 9cyG PROFESSIONAL a A ATO J. A, �� STRUCTURAL ENGINEERING P.O. BOX 958 OCCIA DESIGN SERVICES E. HAMPSTEAD,NH 03826 NoU3 67 � t��E� TA ! (603) 329-5540 ,o FAX (603) 329-6406 �o �EGISTER�� ��`� Qd ��wD� tz RESIDENTIAL� COMM � TITLE �1�� ?L%. EST .) NO . J 0 B SUBJECT 'E\%LQA7V (I SHEET N 0 . DESIGNED BY DATE„_ CHECKED BY DATE (etus� "Tus i t o 8 i 10 lv- v� i!1 1 LT�Z(�• �jH� Mq��gc PROFESSIONAL LVATORE J. tiG STRUCTURAL ENGINEERING P.O. BOX 958 DESIGN SERVICES E. HAMPSTEAD, NH 03826 MOC IA p (603) 329-5540 RO, W "' �-�� `�wK r 1J A FAX (603) 329-6406 ,o RESIDRESIDENTIALNo. 3 L• COMME 7 p ss��NAI TITLE t)k-�Zf- t ice.!' JEST OB j NO . - SUBJECT O .SUBJECT F—OA-OVVlffya h1 CLv{,ISTNaC% ULV, CAMj SHEET N0 . DESIGNEDBY ATE ' CHECKED BY DATE Lo..1J �.1 �� �L �� , � �N� � �...l�fi�t13� f�►Q t�`T��"'�"1 G 1a g` Y S Ps ���Ma�•. Tn.►fla-�R,�c l.ac�«sc. 1-ma LA 14 ��r- V 7ZC'• 9lyG PROFESSIONAL S L ATORE J. STRUCTURAL ENGINEERING P.O.BOX 958 M DESIGN SERVICES E. HAMPSTEAD, NH 03626 �Q�1L, �' (603) 329-5540 o. 33287 ` '� " 11 1 �� FAX (603) 329-6406 RESIDENTIAL• COMMER AQP �Q\���� �� ' ►Jt3�VC:�'L M ZONAL TITLE DOS I- �c..�a s EST ?t NO . JOB t .J SUBJECT—T_gPQy VrtoiA or- t'► iT oA4, W� fAA SHEET No. DESIGNED BY DATE Z64$ CHECKED BY DATE 5��5 t Cc ht ��,f_•c� M v►mac-ti+'7 k / 6 _05 � b Oki VL �2 Raju V\Te.. � SAV. 92 SUM � 3/ SC)► l to I go 1 (� 0 rT�j'j,('. �ZK ASs9�y PROFESSIONAL L TORE J G STRUCTURAL ENGINEERING P.O. BOX 958 pl DESIGN SERVICES E. HAMPSTEAD, NH 03826 ST U MAL ti (603) 329-5540 o 33287 . FAX (603) 329-6406 RESIDENTIAL• COMMER SS10NAL E� TITLE �e�4� - t:_�sS EST .)t N0 .l:.L.b JOB .7 SUBJECT_ 1PO QN-llow Or- 14( 70.&(k SHEET 140. DESIGNED BY rte" DATES M CHECKED BYDATE . t tit Pat k 1.=-t �� e 4,bea11C.— �' Q '����X�� � ,Q�� fin•. 4, ifs i fs--- � So -- ��`.V'�"��.,,.. �-���"�t�!�* �' R.1'1 t�t1.I f�► "tea 3� , Y f NORT/i "o TOWN OF NORTH ANDOVER , PERMIT FOR WIRING SSACMUS� ) This certifies that /'�'�'14,�e-.4..... ............ , has permission to perform ...-..... ............... .......... ............ ........................... wiring in the building of....•: •....1,, ;?.C.e:....................................... 'A�.. . ,North Andover,Mass. Fee�� . o.. Lic.NaYe9G.............................................................. . �� -'`-ELECTRICAL INSPECTOR Check # 5223 THE COAMOI TREALTHOFAIA,SSWHUSEITS Office Use only DEPARTA1EW0FPUX1CS4FL-H Permit No. 6 0,21 BOARDOFFIREPRBVE MONREGULAHONS527CMR12.VO v� Occupancy&Fees Checked �..� <t APPLICATIONFOR PERMIrT TO PERFO LECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELEC. ICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To thespect r of Wires: The undersigned applies for a permit to perform the electrical work des gibed belo" . Location(Street&Number) Owner or Tenant Owner's Address s Is this permit in conjunction with a building permit: Yes o 0 (Check Appropriate Box) Purpose of Building S'/�►/G/� �¢yJ/� Utility Authorization No. Existing Service — Amp 1,) /�Y Volts Overhead Jx>jerground No.of Meters New Service Amps� Volts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No_of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Np,,of Sounding Devices No bf Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 3 OTHER- r ftmwoeCovmgaRuaottothetegrmvsofNla%xhlsezC imalLaws [have aJmen[Liabi1ityh=mreIblicyinckxhigComp*:Opwatiors Coverageoritssubstantialequwalent YES �NO [hawsubmiWdvalidpMofofsametotheOffim YES IfyoubavedkdcedYES,pkmindcattheMmofcoveageby �lrgthepriale box _ NSURANCE OND OIHM (Plea9eSP Y) Expiration D,* Estirn&d ValuecfE1cchical Wodc$ NorktoStart InspX iMDateR 1 Rough Final >igned underlie Peres of perjury. IRMNAMMEE ,,,/► �d /f liomseNo. ' icensee/J/�`il/Clr( f/'l rG/1t97// Signature f/ r cv LicffwNo Business Tel No. ,ddresc AIL Tel No. >WNFR'S INSURANCE WAIVER;I am aware that theLimrse does nothave the insurance ooverage orits atsut ntial egtuvalent as ragmedbyMassachuscits Geral Laws >d that my signature en this peunit application waives this requirement 'lease check one) Owner ® Agent ® t Telephone No. PERMIT FEE rgna ure ot Mwner or Agent z r The Commonwealth of Massachusetts rA d Department of Industrial Accidents Office of Investigations Boston; Mass. 02111 S�1b Workers'Compensation insurance Afdavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Company name: Address f City: Phone#: Insurance.Co. Policy# J Company name: { Address �- City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties cf,a fine up to$1,500.00 and/or one years'imprisonment-as well_as_civil.,penalties in She farm of-a_ST.OP.WORK.ORDER..and_a fine.of_(.$1AO.0)_a stay. against..me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name P:hone.# t Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Q Licensing Board Selectman's Office Contact person: Phone#: Health Department Other 0 ► 73 Date......................... /.... �aORTp TOWN OF NORTH ANDOVER ° PERMIT FOR WIRING SSACMUSEt This certifies that .. u.�. � '� r� ..... . ................ ... .......................................... has permission to perform ... � �»"v ..............wiringmof... ...... ....... .:............ wiring the building of...���.......t. ....` ......�.��...�:,............ at �� 9� ✓�� /� . ....�. `�....�.' y T ......... ,North Andover,,Njass. Fee. ./.. Liicc.No . 'y. ... c ELECTRICAL INSPECTOR Check # 2,9 ti 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-With thtprovisions of M.G.L.c.143,'§.3L,the permit application form to provide notice of installation of wiring shall be uniform throughout l be filed" on the prescribed form.After a permit application has been accepted by an Inspector of Wires ppointed pursuant o M.IG.L c.s166,1§32,an electrical permit shall he 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 maybe deemed_by theJnsp.ector_of_W4res0abandoned.aad.invalid,ifhe—. 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 perm emmitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the pitapplication. ❑ 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 promot6job:growth and Iong-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 dxteuds,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effector existence"during the qual'mfying period beginning on August 15,200 .and extending'through August 15,2012. nle - Permit/Date Closed: * Note:Reapply for new permi - ❑Permit Extension.A..ct—Permit/Date Closed: Commonwealth of Massachusetts official Use Only Department of Fire Services Pernut No. /a/ 7,-s Occupancy and Fee Checked _ ` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07J (leave blank APPLICATION FOR PERMIT 'TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 CMR 112 00 WORK�R� (PLEASE PRINT LV RI W OR TYPE ALL INFOR ATION) Date: City or Town of: NORTH ANDOVER To the Ipector of Wires: By this application the undersigned 'ves notic of his or her intention to perform the ele trical work described below. Location(Street&Number) Owner or Tenant � .,v��'� Owner's Address S9 Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building ZeP51Ae"-1 a(? NO ❑ (Check Appropriate Box) Existing Service Amps Utility Authorization No. / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps _/ _Volts Overhead ElUndgrd ❑ No.of Meters Number of Feeders and.A.mpacity Location and Nature of Proposed Electrical Work: Com_letion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires • Na.of wC ed'._Susp.(paddle)Fans No.of Total No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool Above arn ❑ In_ o, o mergency lg g d• nd• � Ba. Units No.of Receptacle Outlets No.of Oil Burners Fes 'A—LAp IS NE.of Wines No.of Switches No.of Gas Burners No. of Detection and No.of RangesInitiatin Devices . No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW_ No.of Self-ContaineTotalDetection/Merting d Devices No.of Dishwashers Space/Area Heating KWMumex al Local❑ Connection El Other No.of Dryers Heating Appliances KW Security Systems: No.of Water KW No.of No.of Devices or E uivalent Heaters No.of Data Wiring: Signs Ballasts. No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring; OTHER: No.of Devices or E uivaIent Estimated Value of Electrical Work: each additional detail if desired,or as required by the Inspector of Wires Work to Start: (When required by municipal policy.) 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 cove is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER I certify, under the pains and pe"es er u that the in❑orma•on oh this application is true and complete. P J 7', FIRM NAME: r C� �^ asr�PG Licensee: 2 r,,l LIC.NO.: ��f `�`� CZ n'L Signature (If applicable, enter" em "int licens umber 1y'ne.) LIC.NO.f-� /� . Address: B / rubs. al ��©V Bus.Tel.No.:9&�w *Per M.G.L c. I47,s.57-61,security work requiresc Safety Alt:Tel.No.: o. OWNER'S INSURANCE WAIVER; I am aware that the Licens a does not have the liability insurancLicense: Lic.e covers e 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. ^ p PERMIT FEE:$ S ELECTRICAL PERAUT NO. ELECTRICAL INSPECTOR-DOUG SMALL REPORT: I.ROUGH INS ECTION: Passed—[ ' Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: / I- ow (Inspectors'Signature-no initials) '' • Date 2.FINAL INSPECTION; Passed—[ ] Failed—[ ] R Inspectors'comments: e-inspection required($50.00) (Inspectors'Signature-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00) Inspectors' comments: (Inspectors'Signature-no initials) Date A.7NSPECTTON—SERVICE: - DAT+CAt,LED NATIONAL GRILi: Passed— NAVE: [ ] failed—[ j Re-inspection required($50.00) Inspectors' comments: (hspectors'Signature-no initials) Date ; 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Inspectors' comments: Re-inspection required($50.00) (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FELLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF 550.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, AM 02111 www-m Workers' Compensation Insurance Affidavit B>�ders/Cont Applicant Information rectors/�+lectricians/Plumbers Please Print Ile ibi Name(Business/Organization/Individual): C Address: City/State/Zip: /yy► o - Flo ✓y. 1�'l tql one#: Are .,you an employer?Check the appropriate box: I.ICS"1 am a employer with 4. ❑ I am a general con7and Tie of project(required):employees(full and/or part-tim )e .* have hired the sub- 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 �• ❑Remodeling ship and have no employees These sub=contractors have working for me in any capacity. workers' comp.insurance. 8• ❑Demolition [No workers'comp. insurance 5. ❑ We are a corporation and its 9- ❑Building addition 3required.] officers have exercised their 10.❑Electrical repairs or additions .❑ I am a homeowner doing all work right of exemption per MGL .11-El plumbing repairs or additions myself. [No workers'comp. C. 152, §1(4),and we have no . in required.] fi e rt to ees. 12•❑fool ropr�irs p Y [RTO workers' t comp.insurance required.] 13.[] Other " Y aPPECant.ha-,Chec s box#I must a:so ill cat the section nelo natr n +.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. bcompensationpo ick infor—at, $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: Q /�� ¢c7�!' . Attach a copy of the workers'co ��. City/State/Zip: �d! compensation policy declaration page(showing the policy number and expirationate). 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 cern under the erns and penalties perjury that the information provided above is true and correct Si afore: Phone#: FF- Phone only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son• Phone#• .M. Date..1....:..........................� NORTH TOWN OF NORTH ANDOVER - A PERMIT FOR WIRING ,SSACMUS� This certifies that Cr/ ............................................. ....................................... ... has permission to perform .....t � (utio,��ggp .. ..L............... ................. ............ wiring'in the building of...........RG?�. G.g.'5................................................ at... � &.1-1,473W. ................. .... .. .North Andover,Mass. P o r 531 �� �...... �r Fee.. '�....... Lic.No........ ,..... . ........... ELECTRICAL IN ECTOR Check # ' 0778 e` commonwealth of Massachusettts Official Use only - • Department of Fire Services PemutNo._ 1 D 7 78 A � 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(MW27C12.00 (PLEASEPMTVV NK OR TYPEALLINFORMATION) Date:City or Town oh NORTH ANDOVER To theInspect : By this application the undersigned gives notic of his or r i tentio topeTiU111 the electrical work described below. Location(Street&Number) 0 � � Owner or Tenant (j.�,z� Telephone No. Owner's Address Is this permit in conjunctioiwith aby1ldmgpqy4m . Yes ❑ NoP (Check Appropriate Box) ,r Purpose of Building I Utility Authorization o. Existing Service 106 Amps I to / LV6 Volts Overhead❑ Undgrd No.of Meters l New Service Z0 Amps /ZO /ZYO Volts Overhead❑ Undgrd V No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion :following table may be walvedby the Inspector of Wires. No,of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers K'VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No,of Luminaires Swimming Pool AboveIn- ❑ o.o mergency ig ng rnd. rnd ❑ . Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No,of Switches No.of Gas Burners No.of Detection and Initiating Devices No,of Ranges No.of Air Cond. Total � Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons : KW No.of Self-Contained Totals: "'"""'"'"""""""'' Detection/Alerting Devices h No.of Dishwashers Space/Area Heating KWLocal❑Municipal ❑ Other Connection No.of Dryers Heating AppliancesKW Security Systems:Y• No.of Water No.of Devices or E uivalent No.of No.of Heaters KW SiEns Ballasts DataNo.ofirDevices ort uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices oar E uivalent =n?,--Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of ectri al Work: When required by municipal policy.) Work to Start: Injr� a requested in accordance with MEC Rule 10,and upon completion. INSURANCE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provi es proof of liability insurance including"completed operation"coverage or its substantial equ'valen The undersigned certifies that such c v rage is in force,and has exhibited proof of e o the elmit issuing ce/ CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 7/ �/• j �p Icertify,under the pains d enal 1- fper'a thn_t the' o non is application is true an or rete. FIRM NAME: C/ ( LTC.NO.: 55 3 Licensee: �^ H Signat re LIC.NO.: (Ifapplicable,enter a pt"brthe&ceng number line.) Address: Bus.Tel.No.• ! /�i 4i Alt.Tel.No.: *Per M.G.L c. 147,s. 7-61,security work re4dires 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 F1 owner's a ent. Owner/Agent ._ Signature Telephone No. [ Ri�T FEE:$ _ JE►X,1�+ICTS.ZC'.Ay�rye�'(F►�ry7d'/I�1•p®p�.�Ypyt�(+7� _ Ine rn'Ll..�i-4��.�f.LL`II�.R.fLr'LAO.C9.'y .' :_ � • ., �_ * M rilssed I I 'aileft-[ 7 e-zuspeetzoxt xegwixed'( �O.OD) Inspectors'caxuxneats: (xnspectore signatuxe-)Io YlAtials) Date rasseaL Re-inspectioxi.required($50.00) I Inkiest s'comke Z (tns�ectors';9i ature o initials) date Passed-- Failed-I ) ate-xnspectzoraxec�uixecT($ 0.40)�I Inspectors'coxnm.ents: , [lnsp ectors',signature-•no idnls) Pate 4.WSF)gcnoN—sWvjc9: !)A!,-,Di CAL IED NA ±0N'A i C-91i : HM • Passall-[ ) afied-I ) fie-inspectionxequirec { 50.00) I ynspectoxs'commxnepfs: (�iaspectors' igraature-dao znitials} date 'assed--j } Iailed�-[ - ate-znspectzoxtxeciuixed($50.00)�[ aspectoxs'coxnxn.ents: 5 • 'Pspeetors'signatuxe-.no initials) Date DOOP`7 AGN.ARS TO BE KAIND 0AMFT OXISITE R TM AREA TO BE WSTEOTED IS NOT .ACCESSIBLY,AND.A.RE USPECTION OV$50,00IN TO BE+CMRM. -