HomeMy WebLinkAboutMiscellaneous - 7 BONNY LANE 4/30/2018 7 BONNY LANE
210/062.0-0034-0000.0
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule S: In accordance-with theprovisions of M.G.L.c.143,'§.3L,the
Permit application form to provide notice of installation of wiring shall be uniform throughoutfhe 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 shalLbe limited as to the time of-ongoing construction.activity,and maybe.deemed by_the.Inspector_of_Wires ab andoned_and-invalid.ifbe-_.
or she has determined that the authorized wor%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 ofthe Acts of2010 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 ofreal property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,anypermit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,20 and extendingthrough August 15,2012.
i
e —Permit/Date Closed: Note:Reapply for new perm
❑Permit Extension Act—Permit/Date Closed:
9562
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PERMIT FOR WIRING
-SS' USES
This certifies thatU M"q S �,�- Lam/
............................ ... . ................
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has permission to perform 'SGS � ........................'
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Viring-in the building of..........................V 0?11....................................
at......1...&'*.e ..%......G�Z�...................... .. *. ,North Andover,Mass.
Fee... ".�... Lic.No.�.....� .......... .c ... ........................1/"/.............
ELECTRICAL4NSPE QK
Check # Z //
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The Commonwealth of Massachusetts Office Use Only
Department of Fire Services Permit# 9-!r6 2—
BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked
Rev. 1/07 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 2,2010
City or Town of No.Andover, MA 01845-1224 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) 7 Bonny Lane
Owner or Tenant Judd&Maureen Symon Tel.No. 978-208-1286
Owner's Address Same
Is this permit in conjunction with a building permit: Yes 0 No = (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead =Undgrd =No.of Meters
t
New Service Amps Volts Overhead =Undgrd =No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Kitchen/Family Room Remodel
Completion of the following table may be waived by the Inspector of Wires.
No.of Lighting Outlets No.of Hot Tubs No.of Transformers
No.of Lighting Fixtures 21 Swimming Pool Generators
No.of Receptacle Outlets 21 No.of Oil Burners No.of Emergency Lighting Battery Units
No.of Switches 7 No.of Gas Burners FIRE ALARMS #of Zones
No.of Ranges 1 No.of Air Cond. Tons No.of Detection
No.of Disposals 1 No.of Heat Pumps kw No.of Alerting
No.of Dishwashers 1 Space/Area Heating kw No.of Self Contained
,No.of Dryers Heating Devices kw Local Municipal F Other F
No.of Water Heaters JNo.of Signs TV Outlet 4
`No.of Hydro Massage Tubs INo.of Motors Telephone outlet 1
Other: (1)sub panel, (1)toe kick heater
Attach additional detail if desired,or as required by the Inspector of Wires. '
Estimated Value of Electrical Work: (When required by municipal policy.) t
wcrk 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
uidess 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 the exhibited proof of the same to the permit
issuing office.
CHECK ONE: INSURANCE F BOND F_ OTHER F_ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true&complete
FIRM NAME Dumais Electric LIC.NO. 12170A
Licensee Mark A. Dumais Signature LIC.NO. 26665E
(If applicable, enter "exempt"in the license number line)
Address 8 Newport Street Bus. Tel.No. 978-683-9438
Methuen, MA 01844 Alt. Tel No. 978-685-4553
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: LIC.NO.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage normally
required by law. By my signature below,I herby waive this requirement.I am the(check one) F owner f owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE:
N
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Date.el.ii/A
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.y TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SSACMUS�
This certifies that . . . . . . . . . �!!` �/n . . . . . . . . . . . .
has permission to perform . . . . . >,'/ 41. . . ./?�!�? k—
plumbing in the buildings of . . . . . . . . . . . . . ..5v . . . . . . . . .
at . .J. . . . ./Rot! �t y. . . .��'?`�. . . . . . . . , North Andover, Mass.
Fee. .3�.60. .Lic. No../ .�/. .). . . . . . . ../ BGG 1 . . .
�7/ "PLUMBING INSPECTOR
Check ++ /e
83iJ9
y MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASS/ACHUSETTS Date
(f i�1 / Owners Name�� # _
Building Location Permit
Type of Occu anc
New Renovation Replacement Plans Submitted Yes E] No
FIXTURES
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W [-� En
S[B--ESSE
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2N k FL"
3m FLOOR
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51H FLO R
61HFL0CR
7FS FLOOR
SIS FLOOR.
(Print-or type) ,Q �,� c� ,�� � Check one: Certificate
&
Installing Company Name � Corp.
Addres Q Partner.
AMU Ir
Business Telephone Firm/Co.
Name of.Licensed Plumber:
Insurance Coverage: IndicatT
a of insurance coverage by checking the box:Bond ❑
Liability insurance policy Other type of indemnity.
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner F1 Agent
I hereby certify that all 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 Permit Issued for this application will be in
as setts to P vt ode and Chapter 142 o the General Laws.
compliance with all pertinent provisions of the M
By: Signaulre ol:376enseanumber
e ofPlumbing License
Title
Citynown ice a N um o er Master Journeyman ❑
.APPROVED(OFFrCE USE ONLY -
The ComnzonweaZih of Alassachusetts
Departmenfaf., ndusf ialAccidents
Office of-TAVesiL,adons
60.0 Washington Street
.Oostan, 3L4 OZXXI
www mrzsS_gov/dia
Workers' Compensation Insurance fidavit. Builders
/Contra
A n licant Information ctors/Electriclans/Plumbers
• Please Print I,eaibly
Name(Business/Organization/Individual):
Address:
City/Slate/Zip: _ Phone#:
-Are you an employer?Check the appropriate box:
1.❑ I am a employer with 4. ❑ I am a QType of project(required):
general contractor and I 6.
employees(full and/or part-time).* have hired the sub-contractors ❑New construction
2.❑ I am a sole proprietor or partner- Misted on the att ched sheet t 7• ❑Remodeling
ship and have no employees These sub}contractors have
working for me in any capacity. workers' comp,insurance, 8 [1 Demolition
[No workers'comp, insurance 5. ❑ We are a corporation and its 9. ❑Bu�ldmg addition
required.] officers have e 10. Elec '
exercised their ❑ incal repairs or additions
3.❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbingrepairs or additions
myself[No workers'comp. c. 152, I(4),and we have no �
insurance required.] t employees. [No v'vorkers' 12.❑Roof repairs
comp.instzzanc(,-req(nuirpd. 13.❑Other
=ny= Plic�at tI>=_ehacks-box m•�t,Iso Ilii cut Lc Qece he ow
Roreeown ^^. ^g~r_i worw�s'coMpeassz!i_. '
ess who submit affidavit indicatin-g that'=.ra'dc�g all-a,,:k an r""'"^..,:.,..'..."":.":
a Coatrnctors that check this box d then hireoutside eontmetors 4d--t 9u mit a new amdavit indicating such.
m st attached an additional sheet showing the-2-c of the sub-contractors and their workers'copolicy
�P• informal oa
-ram an employer that is providing workers'compensation irc szcrance for
informq on. my emplUyees Beloip is the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic.#:
a-piration Date:
Job Site Address:
City/State/Zip-
Attach a copy-of the workers'compensation policy declarati..on page(shovv ng the policy number,and expiration date.
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
nue 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 nue
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 verincatio
g n
Ido hereby certify under the pains and penalties ofperjurj)thrzr the information provided above is true and correct
Siaft ature: _
Phone#.
Official use only. Do not write'in this area, to be completed bj:cit),or town offzczaL
t
City or Town: 1 ermit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town
6. Other Clerk 4.EIectricaI Inspector 5.Plumbing Inspector
Contact Person:
Phone'`:
Information an- d 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 employeris defined as"an individual,parfnefship,•associar_iion,corporation.or other'legaI entity,or any two or more
of the foregoing engaged in a joint enterprise,and including t3ue legal representatives of a deceased employer, or the
receiver or trustee of an individual,partaership,association az,--other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartroL cuts and who resides therein,or the,occupant of the
dwelling house of another who employs persons to do maintemance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such.employment be deemed to be.an employer."
MGL chapter 152, §25C(6)also states that"every state or Io.cal licensing•agency shall withhold•the issuance or t
renewal of alicense or permit to operate a'business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of co.ampfiance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the.performance of public work um-til acceptable evidence of compliance with the iusuraure
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-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'comp=sation incn•`an ce. If an LLC or LLP does have
employees,a policy is required Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for c�onfirmaiion of insurance coverage. .Also be stu•e to situ and date the affidavit The affidavit should
y
LFe re unwed�.o the Vitt' or cy-wm that. he T. i..O-l-the
rip .n+.py,'....Qy S b�1 Y� Y {
ct%riGaes�u tui 11L j r�It'or li is .nf,*. Q 28SFed,'not e.Departmen!of
Industrial Accidents. Should you have any T estions regard^.g t?:z lay or if you are m4 tired to obtain a wark-ers'
compensation policy,please call the Department at the numbe=r 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 providedi.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 ai?idavit indicating current
policy information(if necessary)and under`.`Job Site Address"the applicant should write"all locations in (city or
trown.)."•A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled-out each . .
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this of i6vit
The Office ofluvestigations wogld like to than 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 Co=ctnwealth of Ma.ssachuset-irs.
Departasent of Fndustrial Accidents
Office of lm e s igaflvas '
600 Wa:sl'iinzton street
B0-stQI.4 MA 02111
Tal. # 617-7274900 ext 4.06 Or 1-8 77-1,LASSA- FE
Fay:#6.17-727-7749
Revised 5-26-05 - vmrvv=as&_a•Ov./dia