HomeMy WebLinkAboutMiscellaneous - 853 TURNPIKE STREET 4/30/2018 (2)N
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Date. V11 .............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... .......... ...................................
...... .... ..... ................
has permission to perform ..... <`&Zn.Q .... 6f:?�q
wiringin the building of ................... ............................................,....................
to,
at
........................... .... . North Andover, Mass.
Fee ... Ae#� ...... Lic. Not—Qw . ...................................
ELECTRICAL INSPECTOR
Check 4�—�—
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Commonwealth of Massachusetts
Department of Fire Services
'aM BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.�—
Occupancy and Fee Checked
[Rev. 1/071 (leave blank
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))
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notic of his or her irate 'on to perform the electrical work described below.
Location (Street & Number)y A p i� ,< ��� u/ S �4 >i<-
Owner or Tenant rr CXnl q SS Telephone No.
Owner's AddressGJ1 0 f /011 --
Is this permit in conjunction with a building permit? Yes 9-- No ❑ (Check Appropriate Box)
Purpose of Building Revx Teo X-1 Utility Authorization No.
- Existing Service Z06 Amps 17, /ZJ"�Vol verhead ❑ Undgrd 9 -
New Service Amps / Volts Overhead ❑ Undgrd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: W1y^ (Zito>�b�61
--W
�
Cmmnletinn nfthe following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Cell: (Paddle) Fans V
Total
TransSusp.
Trsformers KVA
No. of Luminaire Outlets
No. of Hot Tubs 0
Generators KVA
No. of Luminaires Z
Swimming Pool Above ❑ In- El
rnd. rnd.
0. o mergency ting
Batter its
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No, of Zones
No. of SwitchesNo.
of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. TotTons
No. of Alerting Devices
No. of Waste Dis posers
P
Heat Pump
Totals:
Number
.N
Tons
•........................
KW
I .................•.....
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
S ace/Area Heating KW
P g
Local ❑ Municipal ❑ Othe
Connection
No. of Dryers
Y
Heating Appliances KW 0
lJ
Security Systems:' (�
No. of Devices or E uivalent
No. of Water KW
Heaters
No. of No. of
Signs - Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total IV
Telecommunications Wiring:
No. of Devices or Equivalent,
OTHER: 49V A:�, t /'�.h C /�=
Attach additional detail if desired, or as required by the Inspector of Wtres.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 2 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE C RAGE: 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 l & BOND ❑ OTHER ❑ (Specify:)
I certify, antler the pains and enaltr
ofperju ,that the information on this application is true anti complete. /
FIRM NAME: l�D �/ �S v lO � /7 LTC. NO.: -4-
FIRM A 011p
_ / /•f I �� - •iI�> � - - � _ � _ ' =- I-_.. -moi ��� %�� / .
t"(If applicable, a ter"the license nit ne.) Tel. No.:ZAddress: l�t.
Tel. No.:
*Per M.G.L c. 147, s. 57-61, securi ork equines D artment of Pafety "S" Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the iabilinsurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a
Owner/Agent PkjwiT FEE. $ L
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
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 0
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass M
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSP TION:
Pass IN
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature: �.
�✓
Date:
DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com
N
The Commonwealth of Massachusetts
Department of IndustrialAccidents
d 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 PERMITTING AUTHORITY.
Name (Business/Organization/Individual):
Address: _C��,
City/State/Zip:,
r-Af
' • I`i�ir�!�titi�
Are you an employer? Check the appropriate box:
AI am.a. employer with _employees (full and/or part-time).*
2.vern a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. FJ 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
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workerscomp. insurance.:
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c.
152, § 1(4), and Nye have no..employees. [No workers' comp. insurance required.]
Type of project (required):
7. ❑ New construction
8. ORemodelirig
9. ❑ Demolition
10 [_1 Building addition
ILL] Electrical repairs or additions
12.0 Plumbing repairs or additions
13.0 Roof repairs
14.0 Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I 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-coiiiractors fiave 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
0 w1
Policy # or Self -ins. Lie. #:�(1�� I h� Expiration Date: / %)
Job Site Address: s J O /�� All "0 1� t3'/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 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.
I do 11ez�', under theRoKs pfidpenaltiesperiury that the information provided above is true and correct.
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
k, f
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
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 -contractors) 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'
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 www.mass.gov/dia
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Deval L. Patrick � O2//OU p -7/0/r� Thomas G. Gatzunis,
Governor f10'ILP� 11dWK'-d2d9-1-22 Commissioner
Timothy P. Murray c/��// /�/ �0/� Thomas P. Hopkin
Lieutenant Governor /J, y �Y Director
Kevin M. Burke 6// /2� �66J!' www.mass.gov/dp!
Secretary
TO: Local Building Inspector
Independent Living Center
Local Commission on Disability
Complainant
FROM: Architectural Access Board
RE: Asthma & Allergy Affiliates, Inc
853-873 Turnpike Street
North Andover
DATE: 5/10/2007
Enclosed please find a copy of the following material regarding the above location:
Application for Variance I✓ Decision of the Board
Notice of Hearing
Letter of Meeting
First Notice
Correspondence
Stipulated Order
Second Notice
The purpose of this memo is to advise you of action taken or to be taken by this Board. If
you have any information which would assist the Board in this case, you may call this office,
or you may submit your comments in writing to the above address.
Thank you for your assistance.
G�
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Deval L. PatrickOJOIL, 0270�7�/� Thomas G. Gatzunis,
Governor '0660 Commissfoner
Timothy P. Murray Thomas P. Hopkin
Lieutenant Governor �'%�2�OQ'� Director
Kevin M. Burke www.mass.gov/dp!
Secretary
Jim Lyons
NEILP Docket No. Cob 222
20 Ballard Road
Lawrence, MA 01843 COMPLAINT RESOLUTION
RE: Asthma & Allergy Affiliates, Inc, 853-873 Turnpike Street, North Andover
On 12/15/2006 you filed a complaint with this office regarding the above premises. After
reviewing all the information, the Board finds that your complaint has been resolved due to the
following action:
Photographic evidence was submitted which shows the parking lot appears to be in
compliance.
Any person aggrieved by the above decision may request an adjudicatory hearing before the
Board within 30 days of receipt of this decision by filing the attached request for adjudicatory
hearing form. If after 30 days, a request for an adjudicatory hearing is not received, the above
decision becomes a final order and the appeal process is through Superior Court.
Date: May 10, 2007
cc: Owner
Local Building Inspector
Independent Living Center
Commission on Disability
ARCHITECTURAL ACCESS BOARD
�N �01 Z—\�' �' \,\\, " - ,
Chairperson I
M
I,
�iAes�C�eZ6a J
r c
o�M SyeJ
Mitt Romney
+•
Governor
Kerry Healey
Lieutenant Governor
Robert C. Haas
Secretary
REQUEST FOR ADJUDICATORY NEARING
Name and address of building as appearing on application for variance
Thomas G. Gatzunis, P.E.
Commissioner
Thomas P. Hopkins
Director
www.mass.gov/aab
do hereby request that the Architectural Access Board conduct an
informal Adjudicatory Hearing in accordance with the provisions of 801 CMR Rule 1.02 et. seq. as I am aggrieved by the
decision of the Board with respect to Sections
Architectural Access Board, 521 CMR.
of the Rules and Regulations of the
I understand that I may request such a hearing within thirty (30) days of receipt of the Notice of Action.
Date:
PLEASE PRINT:
Name
Address
City/Town
Telephone
Signature
State
Zip Code
'LEASE NOTE:
Chis form must be received by the Board within thirty (30) days after receipt of the Notice of Action.
y
Office Use Onry
UI r Lfam unmralth at 111marnsPtts Permit No.
Bepartment of Vu1311L _Adetq Occupancy & Fee Checked
LN
BOARD OF FIRE PREVENTION REGUUTIONS 527 CMR 12:00 1
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 G
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date � _ 7 6-
(X)r or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work d-essc+ribed below.
Location (Street & Number)r / UANP1 /�� `�/� r(
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes _ No (Check Appropriate Box)
Puroose of Suildina Utility Authorization No.
Existing Service Amos _J Volts Overhead I Undgrnd r No. of Meters
New Service Amps _J Voits Overhead Unagrna (` No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electricai Work
No. of Transformers Total
No. of Lignung Ouuets I 'No. of Hct -s � KVA
Abcve.— In- I
No. of Lighting FixtureSwimming Pool grr,o _ crud. _ I Generators KVA
i I No. of Emergency Lighting
No. of Recectacie Cutlets Battery UnitsNo. of Oil Burners
No. of Switch Outlets I No. of Gas 3urners f FIRE ALARMS No. of Zones
Tota: No. of Detection ane
No. of Ranges I No. of Air Ccrc. ±ons Initiating Devices
i
NHeat Total Total
No. of Sounding Devices
No. of Oisoosals o.of Pucs To KW
r•
iVo. of Serf Contained
No. of Dishwashers SoaceiArea Heatiro KW Detec.;oniSouneing Devices
Municioa! —Other
No. of Dryers Heating Devices KW Local Connec:ton
No. of No. of Low voitage
No. of Water Heaters KW i Signs 3ailasts Wirinc
No. Hyaro massage Tubs f . No. of Motors .r/ y Total HP /_
OTHER: i /f/� � !/�/ lC Z4[ -, tt-i"" / tkC �G !� / "✓
INSURANCE COVERAGE: Pursuant ;o the reau,rements of %iassacnusetts general Laws _
I have a current Liaotiity Insurance Policy inclucing CctrKetec Ccerations Coverage or its sucs;antial eauivaient. YES NO _ I
have suomittea valid proof of same to the Office. YES NO L-ityou have checxea YES. -,!ease indicate ;he type)�,NO
cy
chec King the aoriate Dox.
INSURANCE OBONO = OTHER = (Please Scec:fy) (Expiration Oatei
Estimated Value of E!ectrical Work 5
Inspec::on Date Racues;ec: Rough —
Final
to Start
Signed unser ;he PenatUes of
+per
luryY I ^,/ _ t , f /
FIRM NAME �i (iC-i'l. (.Op lX1 LIC. NO. /
Licensee C 1 Signature/ LIC. NOrys �a
? Qt Bus. .el. No.of�
Address �r✓r '� "" y (�J C1 Alt. :el. NO.
OWNER'S INSURANCE WAIVER: 1 am aware that the :c nsee eoes not nave the insurance coverage or its suostantial eeutvalentt estte-
quireo by Massachusetts General Laws, aria that my signature on :his oermit aopiicatlon waives this reautrement. Owner CJG
(Please cnecK oriel
Tetecnone No. PERMIT FEE S 0
Signature of Owner or Agents X-6565
I 558
t WCRTM 1
:;•t:�``°;°"�0 TOWN OF N
PERMIT
,SSACNUS�
Date....,��f ..:.��,Q..'b...
ORTH ANDOVER
FOR WIRING
This certifies that ...... ............�............ ................... ... .
has permission to perform ............ 4?.l .?......
wiring in the building of ..: l ..... . ,,4c ....... ......
.. .. ......`........Z. �!.'............... . North Andover, Mass.
Fee....J... Lic. No% ..........................................................
ELECTRICAL INSPECTOR
WHIT : A
HITN I"
CAN iIG:Building Dept. PINK: Treasurer
PAID