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HomeMy WebLinkAboutMiscellaneous - 70 COMPASS POINT ROAD 4/30/2018 �� BUILDING FILE �, Date`rt ?.��.............. 0 11 "ppT" ti TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Hu Y "<J�/"'� This certifies that..........0 � . .......................................................................................................... has permission to perform...........?..rl..r.......................'"�— .......................................................... plumbing in the buildings of.....�..:.�`'4 (i at..........................................�...........�.... ....... A...*........................ North Andover, Mass., Fee. )'.: ....Lic. No. 20...... .................................................................................tk1d PLUMBING INSPECTOR Check# q �( f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY N ANDOVER MA. DATE 4-2-15 PERMIT# JOBSITE ADDRESS 70COMPASS POINT DR OWNER'S NAME TRUST CONSTRUCTION POWNER ADDRESS: 51 MT JOY DR.TEWKSBURY MA 01876 ;TEL: 5083209337 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑■ PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES-1 FLOORS- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 \,� CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER 1 DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT 1 FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK 1x{_ LAVATORY 1 1 ROOF DRAIN SHOWER STALL / SERVICE/MOP SINK f( TOILET 1 1 I URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES 1 I WATER PIPING 1 SPIGOTS 2 f r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑■ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE 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 AGENT I hereby certify that all of the details and information I have submitted(or entered)regarding this application true an u to to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applic ill be' c ance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME:I MIKE BURKE JLICENSE# 13127 GNATURE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP I ADDRESS: POB 896 CITY: PLAISTOW _ STATE: NH I ZIP: 03865 _ _ FAX: 1,6033780040 TEL: 16033780020 'E CELL: 19784909385 EMAIL: J.LAURENCIO@POWERHOUSEPLUMBING.COM MASTER❑■ JOURNEYMAN❑ CORPORATION N# _2482 _�PARTNERSHIP❑# LLC❑# M UGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTIO OTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date...... � ` ................... OF�►OR7{��� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 3ACHU5� This certifies that ......... .. . .......'........`...........c...'- .......................................... has permission for gas installation ............... ,.?S?:.:_J...... on.................. in the buildings of. .... S` .- .......................... at.............. �.0...... ........... G.s... ...P-4-............ North Andover, Mass. Y� .. Feej.fl�..... Lic. No�.Z.j.......... .......................:.............................................►")'fJ GAS INSPECTOR Check# 0 _ ` L r 0w : ,� :..# 4Z61- Iq A I~+ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY IN.ANDOVER MA. DATE 4-2-15 PERMIT# qA JOBSITE ADDRESS 70 COMPASS POINT_DR _ _ OWNER'S NAME 1.TRUST CONSTRUCTION r� GOWNER ADDRESS: 151 MT JOY DRIVE,TEWKSBURY MA 01876 j TEL: 508-320-9337 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑0 PRINT CLEARLY NEW:❑■ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES 1 FLOOR-+ Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE i GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I hENe a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑■ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE 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 AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this 4896 re to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for thce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: MIKE BURKE LICENSE#113127 _ COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP AD CITY: PLAISTOW_ _ _ _ _ 1 STATE: NH ZIP: 03865 FAX: 6033780040 TEL: 6033780020 I CELL: 9784909385 EMAIL: IJ.LAURENCIO@POWERHOUSEPLUMBINGAND HEATING.04A_ 11 MASTER N JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑■ # 2482___ PARTNERSHIP❑#=LLC i i ZOUGH GAS INSPE TION NOTES BELOW FOR OFFICE USE ONLY FIN IN PE NOTES A4 Yes Noo THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents a Office of Investigations d I Congress Street, Suite 100 4 t Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): POWERHOUSE PLUMBING CORP Address: PO BOX 896 City/State/Zip:PLAISTOW, NH 03865 Phone#:6033780020 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 6 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑■ New construction 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 workingfor me in an capacity. employees and have workers' Y P tY• 9. E]Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.EJ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.1­1 Other comp. insurance required.] *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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: HARTFORD UNDERWRITERS INSURANCE COMP Policy#or Self-ins. Lie. #:04WECIT2480 Expiration Date:7-28-15 Job Site Address: 70 COMPASS POINT City/State/Zip:N ANDOVER MASS.01845 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 violato Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuranrAage verification. Ido hereby certif n er the p ' s d nalties of perjury that the information provided above is true and correct. 1-2-15 Sianature: Date: Phone#: 60 780020 . 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#• GdM�0 W iLTH'OF MASSACHt-SETTS • �. ` ��,uMBE�s ANO +�A ���r��s � � �. 1 S5UIR5 L I G SED AS °A jou . IdRA'EL V BURKEI a • .tu e tl p � r� k. . a J U BVI 7 rWAOUod , - e •. COM 1tCC1WV At: OR.MA'SSACHUSES T t X412:2.,102 s d pBOARD'OF „ PL"UMBE S AN GASF OTTERS FOL" :0W,I NG z M Cil EL W BUR> ,µ,d l 46ittffisM RMA ISE ,SIA ot830-1613 ;� , ��2� �.I 1 ri Date........ ............ .................... NOwTH °� "" '•�~ TOWN OF NORTH ANDOVER PERMIT FOR WIRING sS�CHU9� Thiscertifies that ............................................................................................................................ has permission to perform ...tiJ-e...j......... cv"-- ................................................................... wiring in the building of.........�. ..... . .... s� ..................................................................... l „� X55 e IJ� North Andover,Mass. at ............................ ................................................ Fee ...+.......Lic.No.110A.. ...................... LECTRICALINSPECTO Check4t Commonwealth of Massachusetts Official UseOnly ` Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: q —2-7-1-5 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention top erform the electrical work described below. Location(Street&Number) 70 eOYv1fal5s PQ Lr)T Owner or Tenant Vl {/Lt , L epy% Telephone No. Owner's Address 5/ MIT 13by br1,V-C `'r-esi LSbclry Imm Is this permit in conjunction with a building permit? Yes V No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No.1 25 71.1733`",/ - Existing Service Amps / Volts Overhead❑ Undgrd 0'- No.of Meters / New Service 2c%d Amps Jbl Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f f N Completion of the following table may be waived by the Inspector of Wires. ` No.of Recessed Luminaires No.of Ceil:Sus Fans No,of Total 1(J p (Paddle) Z Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA r AboveIn- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 0 No.of Oil Burners FIRE ALARMS No, of Zones ©� No.of Switches No.of Gas BurnersNo.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons � HeatPump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: ' ""' '"" '"'""""""' Detection/Alerting Devices No.of DishwashersMunicipal Space/Area Heating KW Local❑ Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of KW � Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: Jp No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Rres. Estimated'Value of Electrical Work: !�� (When required by municipal policy.) Work to Start: � —/5 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 0/ BOND ❑ OTHER ❑ (Specify:) X certify, tinder the pains and penalties of perjury,that the information on this application is true and complefe. FIRM NAME: . A LL 12V05 t o LIC.NO.: o Licensee: w. Signature LIC.NO.: (If applicable,e r "exempt"in the license number line. Bus.Tel.No.• 7 Address: fZxc4ns _( Alt.Tel.No.: *Per M.G.L c. 1 7,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. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMITTEE: $ Signature Telephone No. ' i ❑ 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 w \ 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 Q �j 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 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 permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: r: PARTIAL ROUGH INSPECTION: ' r Pass❑' Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUG INPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Co ents: r Inspectors Signature: Date: FINAL INSPEC ON: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: Z Z DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com V The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Foston,MA 02.114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leizibl Name(Business/Organization/Individual): ��P(`` Address: City/State/Zip: Phone#: 2 I- Areyo n employer?Check the appropriate box: Type of project(required): 1- I am a employer with : employees(full and/or part-time).* 7. �Tew construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l l.electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[J Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other f' 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4 #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.' I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: nn t Q Policy#or Self-ins.Lic.#: 'TwC-4W� 70-&2$�20�!!��Expiration Date: < ^2-5 Job Site Address: 70 Qt'�( City/State/Zip: /�� 1QAf&1)e-Y' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify u r e p s an ies of perjury that the information provided above is true and correct. Signature: Date: 7 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#: V Information and Instructions u Y. 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 6f 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the 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 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 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-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' 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' compensatioii'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"Job 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. 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 (i.e.a dog license or permit to burn 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-AMSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia J. --! _ - _s __ L .—-- 1 4 i u i i r v 4 'ZOMMONWEALTH OF MASSACHUSETTS ::: WIMP, • • • • E L,E.CTR I Cl ANS ISSUES THE FOLLOWING LICENSE AS A ' REGI STERED MASTER ELECTRI-CSIAN ALL PROS ELECTRIC CORP I. .ROBERT .W ROSE 2 MARTENS STREET �`s:<, � ! W WI!:LMINGTON MA O1887-1343 11 44>'.A< >a7`/31/<) 366223 Print View Print View Page 1 of 1 , —777�1 447 53.178113 ALL PRO'S ELECTRICWENS CrORPORATIOM AI-27— NT I 27— L All Pra's Electric Cor oration atn�a�ls WILMINGTON,MA 01887 �ceouwruo._ ren+�-rQ40 P sro� o DAM PAY'f V TNFS-iif r �- .� .s2'a I ORDER OF $f /JAL,.r�A[� bO (M� V GG77 `�V DOLLARS ® k414 t�Eastern Bank '^'� , cai - _�✓ -- ----- I MEMD_ tl1t l 7�/_�- .",�,'�cill� .t.✓ �• s . ._.._ �:0i30i798�: k 1:OiL30L7981: 060076?0401+' i40 i 600 76 7040118 4999 Date. Date�411(-5.................. o�,aowrM,M I �o�.N�R�N�H TOWN OF NORTH ANDOVERi +.•' �:'.• °� TOWN OF NORTH ANDOVER ( br PERMIT FOR WIRING i PERMIT FOR WIRING This certifies that..., .............................................. P :rtirtie%that.................. .................. .. .......•.• ............................. This 4 .............................................. nmisslon to perform... .2�J Vl !�Q-. ............................................ has permission to perform G \`� in the building of,,,.., \fz��. i wiring in the building of,.-7(�•�.,x.- �-,,,Co,. 7 Q �g North Andover,Mass. ......(4:..................... ...........North And ..�.... ..............................................................'......rffi.............v P1.1..........Lic.No. WIC A. ..�.5! ......�I.F.CTRIOAL FeeV�..............................Lia No. �. ................................................ r� 1''.L$CTRiGAL tNSi'Ef'IYl # Check a i �i ' Q, 159 13356 -A- -Z '�1` k`� vv-, I r: � m ,tavante.eom/ii/PdntImagev2 jsp r Ltb7 41, C4 i IPrint View Print View Page 1 of 1 i �..-�..A+.....� .,.-v.......�- ,, :�.,: 63.179.113 � 7 xNAM6 ALL PRO'S ELECTRIC CORPORATION ' y 27 2 MARTENS ST OV f 1d All Prd>g Electric Corporation /�_ Q., / es.+rpi��a WILMINOTON,MA01887 r ACCOUNT NO._ � U�4 DATE V wou ORRDER OFrra U $�Z111-- ��, tom' �.✓ «y e w I DOLLARS M.PP= ® oan( dnwaeuo ', j ®Eastern Bank _.._____ ` - - { I 1.800-EASTERN/w■l■m6■nk.anm .�� �.. - /�,'�'■•r'Cr y4, .. - _. ■ ` 3 - .. �:0LL�0i79j, 060Q7670401+' L4O7 30 ?gal: 600?67040118 9999 i � Date W.li.5........ NOnTM O'NONTM,MO TOWN OF NORTH ANDOVER +,�.�•�• °off TOWN OF NORTH ANDOVER PERMIT FOR WIRING PERMIT FOR WIRING �, :4�Y ►�e 644 . S This certifies that,,,,,,,,,,,,,,,,,,, "" ' This certifies that ................................................. ......................!' .. e . iSN has permission to perform.....jN.2!+•J�..................4 ' .......................................... has permission to perform.......... ....Q �� .G'. t........................... wiring in the building of......�.\. ,. \ ................................... d wiring in the building of................ -��I... ° ..................................... �o C ,�... . ....... . at .............. S North Andover,Mass. ...... at..—...7 � ,,..- North Andover,Mass. ` i•T"�v. .. ... .... I ....:...:.....•......................,....., Fee�� ......Lic.No.1.��.�.. Fee O Lic.No. ..l�.�LLN EiscrRien. PK'rQR ................................................ r tris .................................... Check# L t 9 EU;CTR1;AZ.RSPLCMR Check# - 13259 � f�� 2-5 crx.. 13356 3P -1 � �1�'► ► "" a yiI tavante.com/ii/Pzintimagev2 jsp Date.........1. Ib ................ + OF NORTH 03�;. aom TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,sSACHUS�t ...................... This certifies that ................................... A....... ..................... has permission to erfo ................ ...... ...... ..................................... .... wiringin the b > g of........ ..... ........ ...........5 ..... ................ ....... ..........,.......... .. at .. �r .......... G 97 orth A d ver,Mass. Fee'T/�vO.................Lic.No. 1 G.. ...... /�� ELECTRICAL IN SPE {� Check# �� 111 V Date...................... .................. TOWN OF NORTH ANDOVER PERMI OR WIRING SS�CHU This certifies that ...\ki , ........ ................................................ has permission to pe rfo ........................................................................ wiringin the building of.... ............. ..... ............................................................... at .....-� L/V-00 06) orth And ver,Mass. ..**** **"*'***********T*"'**... ..."""*"* *'******"*'***" 0 FeAcl.....................Lic. No. A Lj C�o ELECTRICAL INSPECTOR Check.4 I ir 132 Commonwealth of MassachusWs _ Official Use Only Permit No. IL Department of Fire Services a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 aeave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER 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) Ctl' s Pd,, f- Owner or Tenant TrJs+ &rP6rzk Asn Telephone No. Owner's Address 70 6215gj p,,, E 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 X Amps lad / -290 Volts Overhead❑ Undgrd No.of Meters 5 3 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ake J (del s+'yc+1y✓N s Completion of the following table may be waived by the Inspector of Wires. (� f No.of Recessed Luminaires 157 No.of Ceil: No.oTotal Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 0 Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batter Units C No.of Receptacle Outlets q0 No.of Oil Burners FIRE ALARMS I No. of Zones Q No.of Switches 36 No.of Gas Burners ' No.of Detection and Initiating Devices No.of Ranges I No.of Air Cond. , Total No.of Alerting Devices Tons No.of Waste Disposers I Heat Pump Number TonsKW No.of Self-Contained Totals: "' ...."'.......... Detection/Alerting Devices 0 No.of Dishwashers ' Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* 1 No.of Devices or Equivalent b� No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent ' No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: b. No,of Devices or Equivalent OTHER: � Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (3 a-oy (When required by municipal policy.) Work to Start: -1 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 JZ BOND ❑ OTHER ❑ (Specify:) X certify,under the pains and penalties of perjury,that the information on this applicatio is true and complete. FIRM NAME: f I (R� rk c ar LIC.NO.: o�q5-5- 6 Licensee: Mike, Faf;no Signatu LTC.NO.: o7957S /3 (Ifapplicable,enter "exempt"in the license number line) , Bus.Tel.No.• 7X33 Address: a Mk�Fens St, W',\"t L v, M4 0188-7 Alt.Tel.No.• T7Y' ;LO *Per M.G.L c. 147,s.57-61,security work requires l5epartment 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 agent. Owner/Agent PEXMIT 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 J electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for 6* t notification of completion of the work as required in M.G.L.c.143,§3L. p 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 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 permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed ❑' Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass R Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com � 4 The Commonwealth of Massachusetts F Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA.02114-2017 �� www mass.gov/dia workers,Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMTTTING AUTHORITY. • .,Elease Print Le 'bl A ''licant Information Pros k e, - -C'_ Ccs C� Name(Business/Orgauization/lndividual): ( Address: Ly��n��n bn AJA N&V Phone 178 - 967- q37� City/State/Zip: '1 Are you an employer?Check the appropriate box: Type Of prof eet( ec]uixed)' 1.Q I am a employer with employees(filll and/or part-time). 7. F1 New'doristruot[on 2-0 lam a sole proprietor or partnership and have no employees tworking for mein 8. E]Remo deliitg any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 4 ' JZ.,j.Plumbing repairs or additions proprietors with no employees. 5.F1I am a general contractor and l have hired the sub-contractors listed on the attached sheet. 11 0 Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14.n Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no empldydes.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit•thi affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this bok 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. orkers'compensation insurance for my employees. Below is the policy and job site X am an employer that is providingw information. Insurance CompanyName: n5J c-E_ Expiration Date: 1 f� 1 5 _ Policy#or Self ins. Lie. Job Site Address: -76 Jtn J• City/State/Zip: AJo��� Art da-V Mpg . Cg 45 � f Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e.152,§25A is a criminal violation punishable by 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.A copy of this statement may be,forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under tla ains a dpenalties ofperjury that the infoation provided above is tr.ea ,correct. Date: Signature: 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#: 4 Information and Instrnctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empldyees. 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trusted 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 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 xequired." 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 Pleasb 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 number(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 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"Job 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. 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 (i.e.a dog license or permit to burn 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 wwwmass.gov/dia 4 I v�COMMONWEALTH OF MASSACHUSETTS* I BOARD df I ANS r. ISSUES :THE FOLLOWi't Lf CENSE ASA Alk )`OURN MAN :i:LtCTRI CSI AFI �¢ IZ H*A-!E L A FARING' ,✓1 "t I� I 23 H ORCH`ARb "AVE Z �W RA I LL MA 01830 438 i 12955 `696 O7/I1;�16 6g600