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HomeMy WebLinkAboutMiscellaneous - 859 TURNPIKE STREET 4/30/2018www.ruskin.com Location No. Date Check # 23113 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ 10C%,0O Building Inspector Location No. -7c) Date NoRTq TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ v� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23113 Building Inspector Location O JA, No. C9 .b Date Check # 23113 TOWN OF NORTH ANDOVER Certificate of Occupancy $ M� Q Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Ej $ 1067,00 Building Inspector O� NO .TN 9 J� 9 • •r ,S'S4CNUSES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 726 Date: June 25, 2010 THIS CERTIFIES THAT THE BUILDING LOCATED ON 859 Turnpike Street, North Andover, MA MAY BE OCCUPIED AS a Business IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover MA 01845 Building Inspector Fee: $100.00 Receipt: 23313 The MNELLC 3 CI 1 O z 0 ; H O U a z O t7 �\ O \ � � � � w • per' w u� °o °' /y� •� r o o a U o m w � W o o o G0 w 2 a w cn w n' ii m cn cn 0 ; U M 2 O a) O as O V Z CD O. O CO) � c I Com_ H 0 � -E m co CD �+ In - CL) O i Cc o a a CMa y C o I-" C ccczc O C Z co V H C C C _cc CL cm 0 U) U) W W 19 LLI ,W,ww V/ O � C co O N C V V :nc cc m c o � co CF m m CD CL �� C om V w � scm c Em �mm a • O � N H \ / V CM m ,� N •O [ C :z .ir ca m '~" c : m O� c2 H O m coZ O •� Cf •O Q y m C = m :moo H m N m CO) NJ C O a0.. W = m c_•+ rq- .r. �� 'EL 26 OC p ac ui N E CO3•N Z O V m p m C C4n CD O ` A H•s Cl _ =nm� 43 � U M 2 O a) O as O V Z CD O. 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DiLullo, Massachusetts Registration Number 6033 being a registered Architect hereby certify that I have reviewed the project at intervals during construction: Entire Project: _ Architectural —X — Fire Protection Electrical Structural Mechanical Other (specify)____. and that, to the best of my knowledge, the project has been constructed in compliance with the contract documents and the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the project. 9415 a Date ...... .1..::..2 /—../0.. O'<•��� 's "YO TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......:!.7............G. ���`�................................................ has permission to perform ....... .......................................... wiring in the building of ....1' . i.... E....... �s _a ©cnp................................. at .............................................................5ata.-PT.......... , North Andover, Mass. Fee . .?. 2.. ......... Lic. No. VV'P.r.....................:...................... " ELECTRICAL INSPE R Check # �z�t z -.� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit N°. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO All RK work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTINWK OR TYPE ALL NNFOR ATION) Date: City or Town of: NORTH ANDOVER- To By this application the undersigned his to f ms the Inspector of Wires: gives noticeo or her intention to perform the electrical work described below. Location (Street & Number)!'All Owner or Tenant — (/ G�e2 Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes, No Purpose nD ❑ (Check Appropri to Box) of Building g 10 / LV `r s 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: Com letion o the ollowin table may be waived b the Inspector of wires. No. of Recessed Luminaires No. of Ceil.-Sus No. of Total p. (Paddle} Fans No. of Luminaire Outlets No. of Hot Tubs Transformers � p� Generators KVA No. of Luminaires Siing Pool Above ❑ In- wmm d• o. o mergency ig g � d• —, No. of Receptacle Outlets No. of oil Burners Batt= Units No. of Switches ARE ALARMS 1.7vo. of zones No. of Gas Burners No..of Detection and No, of Ranges No. of Air Cond. Total Initiating Devices Tons No. of Alerting Devices No. of Waste Disposers eat Pumpumber Totals: Tons. �` ' �. �` -- _ KW o. of Self -Contained —_..___.. No. of Dishwashers Space/Area Heating KW D ection/Alerting Devices Local ❑ Municipal 1 No. of Dryers Heating Appliances KW No. of WaterNo. Connection ❑Other Security systems:* No. Devices of of Heaters ' Sis of or E uival mt Data Wiring: BBallal Balla No. Hydromassage Bathtubs No. of Devices or Equivalent No. of Motors Total HP Telecommunications!Muivalt�-nf� n rumen. No. of Devices or Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipal policy.) Estimated Value of Electrical Work: Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such covers is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify;) I certify, under the pains and penalties of perjury, that the inf ormatio FIRM NAME: application ' true and complete. Licensee: LIC. NO.: nu Signature r� (If applicable, enter "exempt " in t e license number line.) LIC. Address: -5 e5 Bus. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requiresDepartment of Public Safety "S" License: Alt. TelLic. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. ent Signature Telephone No. PERMIT FEE: S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, A" 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApPlUcant Information Please Print Legibl Name (Business/Organiza 'on/individual): r� ,o Address: jls�l ,j City/State/Zip: Phone #:_ Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. PT have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.11 Roof repairs 13. ❑ Other ---- ---• ------ - __ — — -V lut Vol ore Section r:e-,— Sno--g their workers' comp—..,kation policy information. t Homeoi- Hers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. I.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. ,i Insurance Company Name; Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 cer pain�,,g�cd penalties of perjury 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 of -ciaL 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 #: ♦J' 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-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' 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 -ext 406 or 1-877-MAS.SAFE Fax # 617-727-7749 Revised 5-26-05 -.. wvvvv.mass.gov/dia. Date .(?,/.. /.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that cj .../ ........r......... . has permission to perform ......P c Lt ....... i plumbing in the b�uriilldings of . .............................. . at ... ,.�.... ! .G �2 ` p .`......... C North Andover, Mass. Fee.. 1.? -Lic. No.. �.)? .`:�. .� ...........`"'�!'t..... . PL6MBING INSPECTOR Check # 8652 41 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location PSI Permit # Owner Amount New Renovation Replacement Plans Submitted Yes No FiXTF TR FC (Pant or type) % Installing Company Name 0�i� 6 . //Ai1 fit r , .- -/L�- Insurance Coverage: Ind Liability insurance policy Check one: Certificate [Tcorp. s'o `3 ❑ Partner. ® Firm/Co. to box: 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 I Owner Agent 11 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 pe1lormed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas us Sta 1 b' Code and Chapter 142 of the General Laws. By:Signature of Eicenw,rum um Title Type of Plumbing License 1,5--2APPROROVED (OFFICE USE ONLYONLYCity/ rcense Number e� Master Journeyman N The Commonwealth of Massachusetts 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 n. Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Va Phone #: 60 -Y �f �,51 Are you an employer? Check the appropriate box: L 21 am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] '..nY applicant that checks box #1 must also ,I l out the +e on be;oi�, Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. [] Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12T[ Roof repairs 13. ❑ Other 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:_/Vblh?/) L*1'` Policy # or Self -ins. pJ-( Liic�#: ` i Iy� jZ�aSj� Expiration Date: Zj Job Site Address: �./�(J%'f es 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 certify under the pains and penalties of perjury that the information provided above is true and correct Simature: Date.: Phone #: 11 Official use only. Do not write in this area, to be completed by city or town off tial City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: r ; 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-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 tavm that the application for the permit or license is being requested, nest 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass._gov/dia - A N TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... b—Al-J �.c ............................ has permission to perform ..... I ............................................... wiring in the building of ....4A I. k -4-X Z -.(l ... T��77' .............................. . .............. at ....... � .... .... ..... . orth Andover, Mass. Fee./2-5—VA—.... Lic. No ................ EIMMICAL INSPECTOR Check v3 /S 7 8744 A d u1" C'ommonwealg o f -Maeaack"jelt! Official Use Only .1JaPar�rrwnt o�,}ira �arvica9 Permit No. 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), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: s— 7 —O City or Town of: e,!' To the Inspector of Wires: By this application the undersigned gives notice of Ris or her intention to perform the electrical work described below. Location (Street & Number) 9$9 TO Y-,) -ti: /so Owner or Tenant 1. yn . ii -a I pct r–y r+V3 Telephone No. , Owner's Address Is this permit in conjunction with a building permit? Yes U No ❑ (Check Appropriate Boz) Purpose of Building,Tnt+C, %/ QUiiL �J 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: �M-S �� �� 3 �yfJ�@ a )Koc e /4C /0.)1 0 LAA CamOletion ofthe following table may be waived by the /ncaerInr n/ If'—c No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires ' Above ❑ n- ❑ Swimming Pool rnd. rnd. o. o mergeney tg ing Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones No, of Switches No, of Gas Burners o. of Detecti5—nand Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: ,um er.......ons ................ o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un cipai ❑ Other Connection No. of Dryers Heating Appliances KW ecurtry }stems:* No. of Devices or Equivalent o. o Water KWo. Heaters o ---70-01 Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspectur o% 1V1res Estimated Value of Electrical Work: (When required by municipal- policy.) Work to Stan: 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 )< BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: j/0,[� ��,t�iPlC�jL �ta,<�gC7/,ciZP LIC. NO.: /W6-3,144 Licensee: 441y/ofJgy�,yy� Signature LIC. NO,: (If applicable, enter "exempt "in the license number line.) Bus. Tel. No...?7r 6,-2 62 ZZ Address: B% z3,g--i--nd,,-,7- ST itt//>U✓ee -.*.4 '0fS Alt. Tel. No. 71- 31.5"-3-731. 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 liability insurance coverage normally required by law/—Gy' y signature elow, 1 hereby waive this requirement. I am the (check one ❑ owner Elowner's agent. Owner/Agent Signature -/" Telephone No. PERMIT FEE: S 14 w