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HomeMy WebLinkAboutMiscellaneous - 64 NORTH CROSS ROAD 4/30/2018 (2) I 64 NORTH CROSS ROAD 210/038.0-0185-0000.0 I �I Date o.-I-�/............ f NOR7N'1 3:;•t:�`` ;•�."�,� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,S$ACHUSEt f�C ti SC r�Ic/l :! Thiscertifies that ... ................................................ ...... ......................... has permission to perform .... i �"� �'° '� . .................... ................................. wiring in the building of...Ddv ?4x&.nd �� /✓O/L �L G/!- S..................4, ornth over,MW. at.... a � — .. ................... .... .. . ELES Check # 10528 r . 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.C.143,§3L,the application permit a p pp n form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed i 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. 'C Permits shall-be limited as to the time of-ongoing construction activity,and may be.deemed.by the-Inspector-of_Wires abandoned-and.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 permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entitystated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this 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 per ❑Permit Extension Act—Permitilate Closed: Commonwealth of Massachusetts official Use only Permit No. A - Department of Fire Services 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), CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2 52 City or Town of. NORTH ANDOVER To the Inspect r of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) C l d— , Owner or Tenant A0 t/q < u Ze r— 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 New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity "Location and Nature of Proposed Electrical Work: Completion of the ollowing table may be waived by the Inspector o 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 No.of Luminaires SwimmingPool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners 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 Heating Appliances Security Systems:* No.of Dryers g Pp KW y 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: e� Attach additional detail if desired, or as required by the Inspector of Wires., Estimated Value of Electrical Work: (J� (When required by municipal policy.) Work to Start: ,Z spections to be requested in accordance with MEC Rule 10,and upon completion. 3 In 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:) I cert,under the p ins and penalti s of perjury t rat the information on this application is true and complete. FIRM NAME: `� LIC.NO.: Licensee: Signature LIC.NO.: (If applicable, enter "exempt"in he licensetuber h e.) Bus.Tel.No.&O 1 —3.2(, c2S Address: J T �- «� Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requireg Department of Public Safety "S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's Owner/Agent PERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):��, Address: City/State/Zip: C2 Phone #: �Q Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet.* [ Zemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.F1 Other *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 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: CJ �"(i 1/f 0 ell Y1 Nt-Q Policy#or Self-ins.Lic.#: 2—l Expiration Date: n Job Site Address: Gf n! �'f/�c City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi(jdep th a' s ies of perjury that the information provided above is true and correct. Signature: Date: z /_/, '? 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#: FR TIER 447 Boston Street, Suite 9 Topsfield,MA 01983 . JUS (978)887-8112 FAX(978)887-8113 Craig McDonald/Owner-Operator February 21, 2013 Town of North Andover Town Hall North Andover, MA 01845 Building Commissioner or Board of Health Inspector of Buildings Board of Selectmen Policy: HP2491778 Insured: Douglas &Kristine Alexander Loss Locations: 64 North Cross Road Date of Loss: December 27, 2012 File No.: C44P-12-6376CM A claim has been made involving loss, damage, or destruction of the above captioned property which may either exceed $1,000.00 or cause Massachusetts General Laws CH. 143 Sec. 6 to be applicable. If any notice under Massachusetts General Laws CH. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, and claim file number. (eY m Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. February 21, 2013 Date Main Office: 447 Boston Street, Suite 9; Topsfield,MA 01983 (978) 887-8112 0 (978) 887-8113 FAX Boston,MA • Boston/Lynn,MA Gloucester/Beverly,MA • Framingham,MA •New Bedford/Fall River,MA Providence, RI • Cranford,NJ • Toms River,NJ • Philadelphia/Bensalem, PA Shenandoah,PA • State College,PA • Williamsport,PA • Winston-Salem,NC 92Date. . . . NpRTIy TOWN OF NORTH ANDOVER Of ��.o ,•,�O PERMIT FOR PLUMBING ,S3AC04USE� 1� This certifies that . . .14A, XYW7 `7 . . . . . . . . . . . . . has permission to perform . . . jDCP ✓� / . .f,.,a'. /'� . . . . . plumbing in the/buildings of . 1J7. . ,fi��,P.lgl.vd�. . . . . . . . . . .•. . . . . . . . . . ., North Andover, Mass. Fee.J:5. .re .Lic. No..10.3 J�. ,/ . . . . . . . PLUMBING INSPECTOR Check # ?? ��,^ S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: /'9 MA. Date: Permit# Building Location..W-/ �fla�9 L (su,yQ ..Owners Name: P PType of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New: Alteration:❑ Renovation:❑ Replacement:[� Plans Submitted: Yes No FIXTURES DEDICATED W 2i SYSTEMS z 0 4 W cc Q Q Za tar 2. Z C to Z < QQ 'A z D a vai u�i W tM = N Q, W I" W t; z ~ 0 N C Q W G Q Q W z W .J Z C C LL t711 0 W I Uj ta+ v = a C' 3 u z < Q 3 a " z ►- 1...Uj W i a Q Q N t/1 �.' 0 �. Q > 0 0 Z Q Q = W Q a m m o c LL s Y 5 5 H H 3 3 3 o a 3 SUB BSMT. BASEMENT t 1 FLOOR 2" FLOOR M 3 FLOOR 4 FLOOR S' FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: t 'J Check One Only Certificate# _ r7 � � ^ [$'Corporation Address: �c4s ,, bLCIty/Town: Stater //�� / ❑Partnership Business Tel:ez,3—8p iwt�/1•5yFax: ❑Firm/ership ny Name of Licensed Plumber. Pj.U�7 , 1 INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 Yes Se'No❑ If you have checked Yes, please indica-*4tf"e 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 Owner ❑ Agent ❑ Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permItAlued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 the enerai Laws. By Type of ense: Tide _ bey SignatVLicensed Plum"ber City/Town aster APPROVED OFFICE USE ONLY ❑Joumeyman License Number: __ 3�l O Date./9`/7./;..... .. Of,Hp D7M ,ti o? TOWN OF NORTH ANDOVER -PERMIT FOR GAS INSTALLATION SACHU This certifies that . . ��!L . . /V�!"!�!, . . . . . . . . A has permission for gas installation ApIx . . . . . . . . . . . . . . . . in the buildings of at . .lo °ss . / !: . . . . , North doves;Mass. 10, Fee.ZSIX? . Lic. No.,/Z3�0 . . ./. . . . .2G% '. . . GAS INSPECTOR Check# 9 79 7995 MASSACHUSETTS UNIFORM APPLICATION FOR PERM,T TO DO GAS FITTING MA, Date: Permit# CityfTown: L7� ' Owners Name: Building Location: mercial ❑ Educational ElIndustrial ❑ Ins itutional Residential Type of Occup pricy: Com [� New; ❑ Alteration: ❑ Renovation: ❑ Replacement: Q'� Plans Submitted: Yes❑ No❑ 1 -- FIXTURES UJ w f i }- q W w O to FN- trj LU 111 0 LL' z F 2 z — W QW p CL W 0 a X v� w W iL t9 O w to O t fi p x �� a ti. l x to L) 111 w w z V) = ul i to x Uj w u7 w w > V W Z 19 J O W O z O N z Q iC Q i=- Z W >. W m Q O 095 = 512M > Oa 4 H > > � ;: U O O u_ 0 O SUB BSMT, BASEMENT e 1 FLOOR " 2 FLOOR M 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: [ orporation Address' _:��ityrrown: State: ❑Partnership Business Tel:Z,4342,3_.���/ Fax:__—__-- []Firm/Company Name of Licensed Plumber/G2 Is Fitter: 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 it dicat a type of coverage by checking the appropriate box below. iBond ❑ A liability insurance policy ( }'� Other type of indemnity ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not ha ve the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this heck One Only Owner ❑ Agent ❑ Si nature of Owner or Owner's A tint licatlon are true and By checking this box ; I hereby ceitity that all of the details and information l have submitted(or entered)r 17[ss ng this app accurate to the best of my Knowledge and that all plumbing work and Installations performed under tie permit issued for this application will be in compliance with all Pertinent provislor of the Massachusetts State Piumbin an hapter 142 c(the General Laws. Typ (cense: i By CRP lumber C3 er Si nature of Licensed Plumber/Gas Fitter Title -- ILj.Master ,I Q O Ctiyrtown !. ❑Journeyman License Number: _1_ `�-!�L_---- APPROVED OFFICE USE ONL _ I ❑ LP Installer I ` Date.....3./..� l... .. 291 NORTH °14,° TOWN OF NORTH ANDOVER OL p PERMIT FOR WIRING `. ,SSACHusE� dd SeC<<�l, 5 .; l.Q.T This certifies that .. ..r' ............... ........... .............................. J i, has permission to perform ......'A.lci 2.�?.I......... ....................... .. : L .i wiring in the building of......... ...... ........�'........'/�1...................................... at..... ..` ... :... !l.sls5..��`''.............................. .North Andover,Mass. E ?c' / �.il� �J Fee....�.,<.:.'.w... Lic.No. ............. ................... .......... .. CTRICAL INSPER c k # 6 3 7 ppppTTnn i WHITE:Applicant 03/11dSIAW'Quilding DeA'� PINfrTreasurer GOLD: File I r Office Use Only q Permit No. CT /�f/I CIJ4t (9ommnn=dt4 of Aasar4aoetto Occupancy&Fee Checked a ppp BgmirtIuent of Iflublic Oafeg X90 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 ward V Area n n APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 l (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3^ 9(D n City or Town of �J D RTE'L R'�DI)��� To the Inspector of Wires: m n The undersigned applies for a permit toStreet & Number perfo m the electrical work described below. C) Location ( �RP��S Kfl�fl Owner or Tenant � 1 L nn ^^ tf ��IV6� iE Owner's Address Z Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) i L Purpose of Building Utility Authorization No. v Existing Service Amps—J Volts Overhead ElUndgmd El No. of Meters o New Service Amps_J Volts Overhead ❑ Undgrnd ❑ No. of Meters -X) C> O Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of alarm system ZE No. of Lighting Outtets No.of Hot Tubs No.of Transformers Total = KVA M m I No.of Lighting Fixtures Swimming Fool Above In- gmd. 1:1 grnd. ❑ Generators KVA v No.of Emergency lighting O No.of Receptacle Outlets No.c'Oil Burners Battery Units c''> O v No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones < No. of Ranges No.of Air Cond. Total No.of Detection and tons Initiating Devices G7 O Heat Total Total No. of Disposals No.olPumps Tons KW No.of Sounding Devic 5 1201; ' o No. of Self Contained Z No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices•--- • v _.. m Dryers Heating vices KW Local Municipal ❑Other n No. of Da ry �De ❑ Connection O No.of No. of ow Voltage No.of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No.of Motors Total HP OTHER: M M Z: 1 INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws 1 have a current Liability Insurance Policy includ- r- ing Completed Operations Coverage or its substantial equivalent.YES O NO O 1 have submitted valid proof of same to the Office. cm's YES O NO O If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE X% BOND O OTHER O (Please Specify) <r Or © (Expiration Date) z Estimated Value of Electrical Work$ n Work to Start 3-,(-q&:� _ Inspection Date Requested: Rough Final �t2 - O� Signed under the Penalties of Perjury: FIRM NAME LIC. NO. 1 2 3 1 0 Licensee Signature LIC. NO. Bus.Tel-No.617-431-5800 Address 60 William St /We llesle-y. MA 02181 AIL Tel.No.b17-43 - 6�7 OWNER'S INSURANCE WAIVEFt:1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as ra- g�ied Massachusetts General laws.and that my signature on this permit application waives this requitement Owner .__ Agent One Telephone No PERMrr FEE$ V Date. . . . . . . . . . . . . . . . . . . . . NORTH A OWN OF NORTH ANDOVER 0F0 GAS INSTALLATION ERMIJ, SACHUS Et This certifies that . . . ... . . . . . ... . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . .. . . . . . . at . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File (Print or Type) NIFORM APPLICATION FOR PERMIT TO DO GASFITTING NORTH ANDOVER , Mass. Date 3 tg Building // , Y ,r� LocationtPy �/py-r� (°yb2d Permit # 2t ki — (?[�/ Owner's 3 Name _ 1A4'1)z STp�, New Qj Renovation ❑ Replacement ❑ Pians Submitted: Yea [gam No h M s o % rn = she tcl G I D J W H o d ~ >+ M U M�1 0 0 � Q at e d w t s N O } 1ty I It X 1L fue-sfrMT. SAfEMENT � IST FLOOR I 2NO.FLOOR I SADFLOOR ITHFLOOA 0TH FLOOR i 0TH FLOOR 7TH FLOOR STH FLOOR ' Installing Company Name L�rv�c�c.- + Check one: Certificate ►ti,.�`n . f7 Corp. Address CJD l-� 6, es El Partnership Wrlrm/Co. Business Telephone Dte z-I Name of Licensed Plumber or Gas Fitter lid i C INSURANCE COVERAGE: Check one have a current liability Insurance policy or its substantial equivalent. Yes 0' No ❑ It you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy Ef Other type of Indemnity ❑ Bond ❑ f OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 1+12 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of Owner or Owner's Agent Owner 11 Agent O I hereby certify that an of the details and information I 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 the permit Issued for this application will be M compliance with all pertinent provisions of the Massachusetts State Gas Oode and Chapter 142 of the General Laws T of Ucense: _ Title Plumber Gaslilter Mini ure o nse of or as or . Master License Number '�O .l0 Joumeyman APPRUVED(OFFICE USE ONLY) TOWN OF NORTH ANDOVER DIVISION OF PUBLIC; WORKS 384 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845-2909 J.WILLIAM HMURCIAK, P.E.,DIRECTOR James Rasta, Jr. � NORTM � Telephone(978) 685-0950 Director of Fngineering 3r e`�,�`Eo;'•.�°oma Fax(978) 688-9573 p Jrattcl(a)foivizofiiortliandover.corn �SSACNUSEt July 24, 2001 Mr. Philip Tsai 64 North Cross Road North Andover, MA 01845 RE:Failure of Sewer Ejector Dear Mr. Tsai: I inspected your site on Monday and Tuesday of this week and established that the Town of North Andover did have a sewer stub for your home installed several years ago.At that time there was no indication of any problem with your force main. But since this sewer stub is in the location of the break we are willing to keep an open mind, with that,I suggest the following: 1. Have Curvier Environmental make the repair. 2. Inform us,with proper lead time,when the repair will be made. 3. We will have a representative from the Town and the Contractor who installed the sewer stub on site when the repair is being made. 4. A determination of the Town's responsibility will be made at that time by this department.If the Town is determined to be responsible,you will be reimbursed expenses. The repair should be made as soon as possible to prevent harm to the environment.I look forward to hearing from you. in ely, James Ran Director of Engineering CC: J. William Hmurciak,Director of the DPW Tim Willett, Staff Engineer Sandy Starr,Health Director Brian LaGrasse, Conservation Administrator Metcalf&Parker,Inc. C;\Correspondence\Tsai 64 North Cross\Tsai Letter 7-24-01