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HomeMy WebLinkAboutMiscellaneous - 90 LACY STREET 4/30/2018O 00153 Date..-� ..�...]../... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This ce?tifies that ...0'/..!..G. �it.c. '�..4.1,P� 1 s �'.. - ...... _ ................. has permiss u -n to perform ........11.I!N ..� ...��A7 ...� �.J,p. r ......... � ^ wiring in the building of ....V......G!G(......1................................................ at .... /� rt-�.....� f (. yrl 4 /�l E �.................. . orth over, s. Q Fee..%3..C......... Lic. No...../. J41RLDIRE CTOR Check # c:9-7-Qa7--- _ 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 instaIlation 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. 01 c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shalt be responsible for the notification of completion of the work as required in' ' G.L. (,.1!43, § 3L. Permits shallbe limited as to the time of ongoing con ction.activity; and maybe deemed by-thelnspectonof_Wires abandoned_and_invalid.if_he— or she has determined that the authorized work has no,.commeaced 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 Clmanter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 23 8 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 certairrpermits -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 qualifyiWeriod beginning on August 15, 2008.and extending through August 15, 2012. ule 8—Permit/Date ❑ Permit Extension Act — Permit/Date Closed: ** Note: Reapply for new permit Commonwealth of Massachusetts Official Use only Io I Department of Fire Services Permit No. t Occupancy and Fee Checked lug 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: `j-- P — / 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) qQ 6�. Sr Owner or Tenant D l Telephone No. Owner's Address Sgde� .P Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 96", 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: eom letion o the followingtable may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- El rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS INo. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I Number ..................................................... Tons ... KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: e" ,e r.Q 41, `I Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 440 % (When required by municipal policy.) Work to Start: �'v oZ—!� 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 [Z BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: --� 6-%L 114 LIC. NO.: Licensee: :JOuk �1}`1/LiALA�t._J Signature LIC. NO.: 6r3VNI 'D, (If applicable, enter "exempt� in the lice se number li e. y�� Bus. Tel. No. X Address: nZ e�p- (/ 5fl f P i7// [ /U/di 6,19!/ Alt. Tel. No.: �2 *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. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Arj� ..,y, •..'y ..f,,; .. .•,..-j Y.;.v.•v,.. ..t:'r Y:'•tt ..;. ..,.:r::{:x;.�:..}..y:.t::: }.Y::::::.::. 1"•tr :.1..•�-.::::. :524¢?�'i�Y.S:<�XY. ..+; . v PATE 1MMfDD1YYt W ©/ I� ;;k% 04/13/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. BOX 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 ! COMPANIES AFFORDING COVERAGE Phone: 1-888-$.13-4949 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY INSURED O'MAHONY & SONS ELECTRICAL INC 276 8240 _ COMPANY O'MAHONY ELECTRICAL SERVICES INC_s 2 DEBUSH AVENUE i COMPANY MIDDLETON MA 01949 C : COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THL TCRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POUCY NUMBER LTR POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) OMITS (° GENERAL LIABILITY 7t COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE —V S 2000,000 —' A __ j I ] PRODUCTS - COMP/OP AGG S 2,000,000 PERS_ON_AL &_ ADV INJURY _ CLAIMS MADE % OCCUR 1 9421851 01/01/11 01/01/12 I $ 1,000,000 { OWNER'S & CONTRACTOR'S PROT ��I EACH OCCURRENCE s 1,000,000 ....-_..,..._....-..__... __.. , _. L......J __.._..._.._.__..,....__... FIRE DAMAGE(ROY one fuel +,$ 100,000 ' I MED EXP IAnV one person) $ AUTOMOBILE LIABILITYANY j ! I COMBINED SINGLE LIMIT s 1,000,000 i X AUTO I I ALL OWNED AUTOS i BODILY INJURY A J SCHEDULED AUTOS 9421850 01/01/11 ( 01/01/12 (Perporaon) I ( v . HIRED AUTOS BODILY INJURY S NON OWNED AUTOS I (Per accident) _ _.,.�.__.......,_-.-.-..__.-...__...._.............._—. i I I j PROPERTY DAMAGE S GARAGE LIABILITY _ _ AUTO ONLY - EA ACCIDENT ANY AUTO I � j._.. OTHER THAN AUTO ONLY; i # EACH ACCIDENT*'! S i AGGREGATE j S i EXCESS LIABILITY ; EACH OCCURRENCE S 5,000,000.. A , X ] UMBRELLA FORM "t 9421854 i 01/01/11 ( 01/01/12 AGGREGATE __- $ s 5,000,000 I OTHER THAN UMBRELLA FORM i s WORKERS COMPENSATION AND I INC STATU- OTH —� X i. TORY UMiT$,I Ef7 - EMPLOYERS' UABIIJTr i I EL EACH ACCID_ENT 5 I A THE PROPRIETOR/ RINCL 9421855 ! 01/01/11 01 /01 /12 .50.0J.0-0.0 ...... . . —._ O . EL DISEASE - POLICY IT S 500,000 l._. PARTNERS/EXECUTIVE OFFICERS ARE: EXCL I . _. EL DISEASE - EA EMPLOYEE is 500,000 OTHER i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS —� �Ii',.,,i..•.... Fsn:. .. \......... .. ..:i:'.:_i:: :....... .. .,'v ..\ .• ., .:.: ...,�,.. ...:.: .:::.:::v .: :. :.,.�/Q .-..... iiCSSvY+ :: 2788240 TOWN OF NORTH ANDOVER 474 ..-......::Sim:;•: .....:.:.. ... &HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BLDG DEPT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BLDG 20 STE 2-36 _J•„y__ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 1600 OSGOOD ST BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR UASIUTY NORTH ANDOVER MA 01845 OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES, ' • , ,i, •AUTHORIZED REPRESENTA71V irQ�EJi+.•... �.3.?': _..:...:.. ._.. ..; .:; .'.c - ,fit grey, rRry y / Yv1 Y,t ty .:7i�t�ii, ,.\i+tiR•,TIi%Fi)�t-,.,'F,.1G?p.: d .r - TOWN OF NORTH ANDOVER �6 C Building Department 1600 Osgood Street Building 2- Suite 2-36 Building Dept"SsgCH�SE��y North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION DATE: TEL #: NAME OF COMPLAINTANT: jawalwPow ADDRESS,--. /'6.9— h Ile -y- S � l COMPLAINT TYPE: �-►�''`- l lectrical• ,�"' , Plumbing: Cf c� Gas: ilding: �� Property Owner: Address: Other: �0 Z/ -Ye y S�e4e r 4y 4i47 //11W -i A. ✓� e L &47-W -e�4, //V -(n �1/eell Signed: dl - Complaint Form - Revised 6.2007 V ele e c�- Jzjllll� -70, "J-3 V- TOWN OF NORTH ANDOVER Building Department 1600 Osgood Street Building 2- Suite 2-36 Building Dept North Andover MA 01845 Tel: (978) 688-9545 Fax (978) 688-9542 COMPLAINT FOR INVESTIGATION f DATE: TEL #: %,2p %G -Y- 2a b NAME OF COMPLAINTANT:"'; = ADDRESS.::.. 1�2 / /15 COMPLAINT TYPE: lectrical: Plumbing: Gas: ilding: Property Owner: Address: Other: — e. 90 L,1ey st�ee, Signed: �^ Complaint Form - Revised 6.2007 o4ls -e 41 -PA,(_ 6 t/ &/'c -- 0 Sia / /" CG w1v-e'e_ ) &e 64,eae j - c 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. j Permits shall -be limited as to the time o£ongoing construction activity, and may be.deemed.by the.Inspector-of Wires abandoned-and_invalidif 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. Mule 8 — Permit/Date Closed: � ��=/ t� . * Note: Reapply for new permii i 6rmit Extension Act—Permit/Date Closed: Date ��S:..G..r�'.............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............:.. f:.c..w-................................. s has permission to perform ....:::..`....``........�. ....? ...:-. r'S^6.............................. wiring in the building of .............................. ........................................ at ....,.�....:>.:::.�''"� `j� .... North Andover, Mass. r / s Fee :. ��� r ...... Li No! U � ................... Check A r / 5 15 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permut No. 73 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee CheckedS [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 ININKORTYPEALL INFORAMTION) Date: S/� 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) 9 �) I- n p y — T Owner or Tenant _D p q n n e 1?7c sic �, ev Telephone No. Owner's Address 90 [.q r-eY, Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Buildin g_ P_ e 5 i `D e n c Utility Authorization No Existing Service Amps / Volts Overea❑ Und rd ----- hd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: ��TI7 2 SIG ?CZ -Tu5r 1- e_ ct Ind F;x-rvt\. Com letion of the ollowin table m be waived b the Ins ector of Wires. No. of Recessed Luminaii es % No, of Ceil.-Susp. (Paddle) F N0 of T No. of Luminaire Outlets otal Transformers KVA No. of Hot Tubs No. of Luminaires In -11o. d. Swimming Pool Above FIRE ALARMS No. of Zones d. No. of Receptacle Outlets �/ No. of Oil Burners No. of Switches �a No. of Gas Burners No. of Ranges No. of Self -Contained No. of Air Cond. No. of Waste Disposers Deteetion/Alertin Devices Heat P�►P Number o Connection KW Totals: No. of Devices or E uivalent vo. of Dishwashers Data Wiring: Space/Area Heating KW vo. of Dryers d Heating Appliances - KW PIU. oI No. Heaters Si s Ball No. Hydromassage Bathtubs No. of Motors Tot, OTHER: 64Th roan Z Fans otal Transformers KVA Generators KVA In -11o. d. o mergency rg g Batte Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices ons No. of Alerting Devices is _ KW _ No. of Self -Contained Deteetion/Alertin Devices Local ❑ Municipal ❑ Other Connection KW Security Systems:* _ No. of Devices or E uivalent of asts Data Wiring: . No. of Devices or E uivalent d Telecommunications Wiring: No. _ZD_ or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: �/�/09 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 Iicensee 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 $9 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete - FIRM NAME: ria ►vi S` T 6 1 11/ LIC. NO.: / Uo-5-2 Licensee: � t., a, n STfG W Signature _ (If applicable, enter "exempt " in the license number line.) a� LIC. NO.: Address: ej s o u -r I-, leo , , S n �T� N n3 Bus. Tel. No.:97� 2 f 7 z z y, *Per M.G.L c 147 s. 57-61, secure work requires D �-- Alt•. Tel. No.: ' q epartment 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 Signature Telephone No. PERMIT FEE: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 *-ashington Street Boston, MA 02111 e I www.mass.gov/dia . Workers' Compensation Insurance Affidavit, Builders/Contractors/Electricians/plumbers Applicant Information Please Print Lembly Name (Business/Organization/Individual): city/state/zip-Phone #: . Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a.sole proprietor have !aired the sub -contractors listed t or partner_ on the attached sheet. ship and have no employees These sub -contractors have working for mein' any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required-) 3. ❑ I am a homeowner doing officershave exercised their all work right of exemption per MGL myself. [No -workers' comp, c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' tA., comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling S. ❑ Demolition 9. ❑ Building addition 10-DElectrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other --• �• ��x m t trust atso nu 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 time of the'sub-contractors and their workets' comp• policy information. I am at, employer that rs pzoviding:warfcers (comp information. ensation insurance for pry. employees; Below is the policy and job site Insurance Company Name: t 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 certify under the pains and penalties of perjury that the information provided above is &ue and correct Signature: Date 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 S. Plumbing Inspector 6. Other Contact Person Phone #• 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 bmstee 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 tate 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 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 cant' 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, nottthe Department of i 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 nurnberlisted 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 lnvestiptions 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 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Date. l / HORT" TOWN OF NORTH ANDOVER O� ..�°;�1'�O p PERMIT FOR PLUMBING SSACMUS� J / This certifies thatlu .......-�.'..`..• has permission to perform '"t''` `:.'` `.� ....... plumbing in the buildings of .............."` r ............... . North at . �) Andover, Mass. Fee ....... Lic. No:........ . PLUM I G INSPECTOR Check # ��-��-' 8061 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location Q j� Owners Name Ute, Permit # G> G Amount Type of Occupancy ' New Renovation Replacement Plans Submitted Yes No (Print or type) / / f Installing Company Name ,c C9 �T f4 x,44 , 6 ,L Check one: Certificate Corp. Partner. Firm/Co. , 2 lob V3 GrName of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ti Liability insurance policy a Other type of indemnity ❑ Bond ❑ 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 ❑ 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 installat' performed .der Permit Issued for this application will be in compliance with all pertinent provisions of the Mas sach tate in de and Chapter 142 of the General Laws. By: n e of Licenseau r Title Type of Plumbing License �— � 4 y, City/Town License um er Master ❑ Journeyman APPROVED (OFFICE USE ONLY `l,-.i.-4LVAIMMMMMMMMMMMMMMMMMMmmm----- :: `Du 00I -------M----------------- 1 ' mmmmmmmmmmmmmmmmmmmmmm-m� m 1 tI:' "-©-®-----------m-------- ,.,1 -!' -------.----------------- '1 $:' ---------.--------------- I ,I:' ------�mmmmm--m---mm� W I #1' MMMMMMMMM MMMMMMMMMMMMM� I fit-, --------..--------------- • C' ---------------.----M--.- (Print or type) / / f Installing Company Name ,c C9 �T f4 x,44 , 6 ,L Check one: Certificate Corp. Partner. Firm/Co. , 2 lob V3 GrName of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: ti Liability insurance policy a Other type of indemnity ❑ Bond ❑ 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 ❑ 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 installat' performed .der Permit Issued for this application will be in compliance with all pertinent provisions of the Mas sach tate in de and Chapter 142 of the General Laws. By: n e of Licenseau r Title Type of Plumbing License �— � 4 y, City/Town License um er Master ❑ Journeyman APPROVED (OFFICE USE ONLY The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Tf-ashing ton Street Boston, MA 02111 c www_massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plltmbers iniiesrnf Tnf^vn..af:.... Name (Business/Organization/Individual): Address: tU City/state/zip: Phone Type of Project (required): 6. ❑ New construction 7. Q Remodeling 8. Q Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other HtiolL omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submuiiry it aanew affidavit indicating such. ;Contractors that check this box must attached an additional sheat showing. Etre name of the sub-cMmuctors and their work' comp. p^„licy irfomudon. I am an employer that is providtng:workers I compensation information. insurance for my employees. Below is the policy anar job site Insurance Company Name: Policy # or Self --ins. LiC. #: Expiration Date: Job Site Address: Attach a copy of the workers' compenCiiy/State2ip: Failure to sation policy declaration page (showing the policy number and expiration date 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 cerf[fy under th ns andpen+eS of perjury that the information provided above is true and eormet Si tore: Date: �' O Phone #: �^ 55"'CJ CJ 61 offwial use only. Do not write in this area, to he confleted by city or town ofcia( City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector 6.Other 5. Plumbing Inspector �� Contact Person: Phone #: Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ I am It general contractor and I employees (full and/or part-time).* 2Z?raam.a.sole proprietor or have hired the sub -contractors listed partner- on the attached sheet t ship and have no employees These sub -contractors have working for mei l any capacity. [No workers' comp, insurance workers' comp. insurance. S. ❑ Weare a corporation and its required.) 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No•workers' comp, c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' camp. insurance required..] T Airy applicant that checks bo><tt I must also fit/ out the section below showing their workers' com Type of Project (required): 6. ❑ New construction 7. Q Remodeling 8. Q Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other HtiolL omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submuiiry it aanew affidavit indicating such. ;Contractors that check this box must attached an additional sheat showing. Etre name of the sub-cMmuctors and their work' comp. p^„licy irfomudon. I am an employer that is providtng:workers I compensation information. insurance for my employees. Below is the policy anar job site Insurance Company Name: Policy # or Self --ins. LiC. #: Expiration Date: Job Site Address: Attach a copy of the workers' compenCiiy/State2ip: Failure to sation policy declaration page (showing the policy number and expiration date 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 cerf[fy under th ns andpen+eS of perjury that the information provided above is true and eormet Si tore: Date: �' O Phone #: �^ 55"'CJ CJ 61 offwial use only. Do not write in this area, to he confleted by city or town ofcia( City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Cierk 4. Electrical Inspector 6.Other 5. Plumbing Inspector �� Contact Person: Phone #: Information a nd InstructionsIlk Massachusetts General Laws chapter 152 requires all emp ;Foyers 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 mairitenanee, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be de med to be an employer." MGL chapter 152, §25C(6) also states that "every state or- local Ficensing agency shall withhold the issuance or renewal of license or permit to operate a basiness or *o 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 t%e 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 complertely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) 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 maybe 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, nottthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' oor .pensation policy, please call the Department at the number. listed below. Self-insured companies should entertheir self insurarnce"license number on the' appropriate line. City or Town Officiais 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 full out in the event the Office of lnvestigations 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 fidure permits or licenses. A new affidavit must be filled out each year. When 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 Investiations 600 Washington Stzt=t Boston, A!IA 02111 TeL # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax 4 617-727-7744 www.mass.gov/dia Location No. b Date •_. NC^A"._ TOWN OF NORTH ANDOVER Certificate of Occupancy $ " Building/Frame Permit Fee $ �'�s',•° ttt' Foundation Permit Fee s�CNus $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ `— TOTAL $ J� A� �J /�! //'i r�s.-� �— ��---r G Building Inspector 07/09/99 12:59 130.00 `+"Div.rn Public Works o a O 0 J W S O o cxa F,xj U ^ fl 2 - U �. C 04 5 M r z S z rn F x C � Z 7_ L FORM U - LOT RELEASE FORM a INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** ✓APPLICANTS t9�C"`��" ""1 HONE /LOCATION: Assessors Map Number S PARCEL SUBDIVISION LOT (S)� I ' JUN {� // Q ✓S T. NUMBER t ,� � long,/STREET r. *******************************OFFICIAL USE ONLY******************* _-�i=;:, RECOMMENDATIONS OF TOWN AGENTS: z � 5 CONSERVATION ADMINISTRATOR DATE APPROVED 2 DATE REJECTED COMMENTS �y �1 �`''U�-' VV( 1^ `yV TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSP CTOR- EALTH DATE APPROVED DATE REJECTED SE.P INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS LaGaTi�s� a C" t eJG �� KD (MD�y.1 �L`oCJ�cQ, (c�GZ% PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR • Revised 9197 jm DATE N/F � M w Map 105C, Parcel 27all 0 m M LOT 20 z O M 0 65,907 s.f. 1.51 Ac. Proposed 1 story Addition Area= 196 s.f. :� 48'a° _ 13. if 2 .2' Exist. Build. 2-1/2 shy, wd. kn. 32' 12 # 90 1 Floor Area=1,300 s.f. I 1.2.00' -_ Total Frontage — 10 SSI o 19.13 85.20' 59 B N 30021'50" E LACY STREET • (Width Variusj / Map,105D Parcel 47 N/F Thomas P. Coppa #102 Lacy St. , Map 105Q p 105C Parcel 170 cel 30 N/F N/F ara. Tighe Barabara Tighe cy St. Lacy St. 6, s 4. TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units ... or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. d G Type of Work: �.(��-u- Est. Cost -/ a0; OD -0 s Address of Work Owner Name: D iQrte4=46 �-4c (PA {` Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. a 9 Job under $1,000 Date 9 Building not owner -occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL C. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: 62 D to Owner Name r cr North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number .?, bIII is that the debris resulting from this work shall be disposed of in a prop�icensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: / (Location of Facility) / 0 Signa ure of Permit Appi nt Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit I Name Please Print Locution: 0 �'' " ! Sf_ __ + C;tv �Dil-ISL+ J`rA%1J0%� Phone K, I I am a hcmecwner performing all wcr11K myse!f. F- FjI am a sole proprietor and have no one working in any capacity u I am an emelover providing workers' compensation for my employees working on this job. Comoenv name: Address iNi Phone --- insurance Co. POlicv m INS Add Phone TM: Insurance Co. Policv # Failure to secure ccverace as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties cr a fine up to 51,500.00 and/or one years' imprisonment as we!I as civii penalties in the farm of a STOP WORK ORDER and a rine cr (S i 00.00) a day against me. I understand that a troy cr 'his _zatement may be forwarded to the Office cf Investigaticns of the DIA icr ccverage venfoonon. I do hereby certify u} r the Gains and penalty s of erjury that the information provided abcve is true and cerrec:. Sicnature Print name 4ac 6AkV,&-V Phone # Offical use eery do not write in this area to be ccmc!eted by city or town crfJc:ai' City or Town Permit/Ucensinc Building Dept ❑Check d immediate respcnse is required ❑ Licensing Ecard Selectman's Office Ccntac: person: Phone r C Health Department C Other O E=4 44 me CL �. : c r- �a�c O u z ' � m O Z is _ m a U m • � •mo a UW -- a� z w A CO O .oa coo0 m O � v w + R 'o Z w 12 c� w O a�' w a PO o cin v o cn cz me CL �. : c r- �a�c N _A m m 3 ' � m O: S qt is _ m •= c m • � •mo a� CLU V CO O coo0 m O � �c + R 'o Z oc a o Q, C cc ' O m C c N m SS sd r0+ uiCLC N O A R C y f.. N .E o` m CL_Cos v m W 0 V .mom 0 CL tj `j E C I 0 cCD 1 6 8 CD €OO A L 0 LU 0 Cn U) W W Ir U) me CL �. c N _A m m 3 ' � m O: S qt is _ m •= c m • � •mo CLU V coo0 m O � �c + R 'o Z oc a o 1 - yr N m W C r0+ uiCLC N O A R C f.. N .E CL_Cos v m co,m�� V1 a m O fl A =�a�m 0 a �O 8 CD €OO A L 0 LU 0 Cn U) W W Ir U) U*1 ll� 14L Qlt ( 2 4'-/)l--00 I 11 � 0 'rf I -�r dL*", )6s c�� k9oo-Of 141 / 1 16 �1j�f O'C' v -o Fcf ( e, I-T;l ril lo -/,/ o loor- 'Uo dsf /t/o, or . + (�> c? `, 4 CA c. Vl) I 1 �6 SQL 1K �� U f IT, i" 1900 I i i I 10 t -gin .��. � 01.L CAT y I I 16 i e7 X k r'o GCrI-Tm lli/offo� / r- to or '75;-� J s f l6 "A I� I LN • / i� 1 /�- ` b����w.`O�. sCa I P � ll - -.411% i1 Date . /.-. TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSA` 5� • / This certifies that ........ has permission to perform ..<rr - r<• - t!................. plumbing in the buildings of.... -r `/............ . at. �� . , N( , Andover, Mass, Feed ...... Lie. No.......... ... .............. PLLL EL f, INSPECTOR Check # ��'"?2 6297 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 4�11 j .— (Print or Type) A / i�fMass. Date ?�c4 _ Permit# [� Ak 1 Building Location Owner's Name ..t .4 11 Type of Occupancy'L&51 E N Ti r-1 i✓_ New ❑ Renovation ❑ Replla�ement Pians Submitted: Yes ❑ No ❑ 1,f TURES Installing Company Name A , c3 e -r IQ - X1461 M A TA� C7 Address '�() COACHmt4n) t -PJ !Y) E %N1,145 -A), 411`4 01,ficl�! Business Name of Licensed Plumber Check one: ❑ Corporation ❑ Partnership Certificate INSURANCE COVERAGE: I have a current ' ility 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 coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ 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 poormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum' g jtode and qapter of the eral Laws. re o LicensedPlumber L Title Type of License: Master % Journeyman ❑ City/Town APMXWEffT0TF115EU L License Number -q34—; a 4 m m I m m 'O 0 O m N N z N V m A O z 0 w m I- 0 IE In O w O In M 0 m c N m O z AS J l > c 0 V > � O � Z � p � O � m Z c O r ■ � O c z =r m C C m Q ; Z -4 0 O 0 r c 3 Q m m 'O 0 O m N N z N V m A O z 0 w m I- 0 IE In O w O In M 0 m c N m O z AS J l N° 1801 F � �sS�cMusE� r r% .; Date ...'!:� ............................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ' R ..................... '� ' .. .......................................... . ............................: ...'....... has permission to perform . �}-.'" `'::-.. r................................................................ wiring in the building of at ..... a.......:! �� ,North Andover, Mass. Feed Lic. No::,:.: `D� .......... ELECTRIC AL INSPECTOR 08/04/49 11:46 25,00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TBE CPWONWE4=OFA14MCHUSE77S DEPAR71 ENT 0FPUBLIC&4P= BOAZD OFFNEPREVEMONREGULITIOM 527CMR 12: oo Y i FORWARD Office Use oniv Permit No. /fij/ Occupancy & Fees Checked APPLICA Z TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS FI-FCTRIC.AL CODE, 527 CMR 12:00 (PLEASE PRLT I' IN TNK OR TYPE ALL fINTORMATION) MAP 1� UZI Town of North Andover I the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below PARCEL--! Location (Street &Number)% D Z' % • --�' Owne. or Tenant Owner's .address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building r Utility Authorization No. Existing Service 1-4,2V Amps a0 /';NOVOItS Overhead j� Underaround No. of Meters , Ne.v Service e226ZO .Amp,f% /o?cJG'VoltsOverhead Underground No, of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No of Lighnng Fixtures Sw mining Pool Above Below Generators KVA and around No. of Receptacle Outlets No. of0il Bumers No. of Emergency Lignimg Battery Units No of Switch outlets No. of Gas Bumers FIRE ALARMS No. of Zones No of Ranges No. of Air Cond. Total Tons No. of Detection and No of Disposals Nod of Heat Total Total Pumas Tons KW Initiating Devices No. of Sounding Devices No of Dishwashers Space Area Heating KW No. of Self Contained --1 Detection/Sounding Devices Local a Municipal Connections Other No of Dryers Heating Devices KW No of Water Heaters KW No. of No. of Signs Bailasis No Hvdro ,Massage Tubs No. of Motors Total HP OTHER lrs rc Cie Pu ram to the ra}tnrer aN4assad� Genet -al Laws I f ire a esr>;� L aaiay irn�sar P icy Qrfiu,Q Carle Com a i>5 erruvs YES NO I h ; e s daniued �a6d pa�f of Offix. YES NO If}w ha,,e dtd ed YES, p! tt� type Ofarraage by g tt� �1T� fes. Lam! o CvSLRANZE BOND OTI$x (Sp) ///,-? / Esmmd ValieofFl2cvical Waif Wcrk ID Start iq=m lw E RcLigt ✓✓ Final FIRM So -ed uixk:rTft y NAME rl 26 C�/ LJ �1 L came Na���� L' --,see 76/ 5�& - 7d�S Bus-�s Td. Na -A0 ---326 s .Ai Tei No. OWNER'S I]NEURANC W.kMDE , I am awarethat Liffe the icsua ca ✓ crus s ! e pact <as � by � G ai Lzr"s a� the my sgz�aa>rrn this p� r�poc�at wanes th5 � (Please check orae) Owner Agent �✓ Telephone No. PERMT T FEE g s \4 f Date../7-,-;3 of N2 3,55 .............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that............................................................................................... has permission to perform ........... , .................................... ............................... . ...... . .................... wiring in the building of .. ................ %. ........... at..... / ....... ............ t .....—/........................ ............. No Andover, Mass. Fee.A� .............. Lic. No . ........ I-- —E'LE*CTR1CAL*1NSP'EcT0R' Check #&,JW— WHITE: Applicant CANARY: Building Dept. PINK: Treasurer � 1 \`r No 01 42 GIITIinianlutalt4 of f alwar4uuttlli Office Use Only Department of Public Safety Permit uo. T� [ `rS BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 -EW Occupancy & Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be periormed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7-23-01 City or Town of NORTH ANDOVER To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 90 Lacy Street Owner ori Diane McGarvey Owner's Address Same as ahave Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Existing Service New Service Number of Feeders and Ampacity Amps Amps /. Volts Volts Aility Authorization No. _ Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work Wiring for new Well pi= No. of Meters No. of Meters OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESXXNO ❑ ! have submitted valid proof of same to this office. YEM NO ❑ Faxed 7-18-01 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE RR BOND ❑ OTHER❑ (Please Specify) National Grange Mutual Iris. Co. 3-11-02 (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME Laroche Electrical, Inc. Final _ LIC. NO. Licensee Arthur W. Laroche, Jr. Signatur LIC. NO. MR 13 Address P.O. Box 482, Londonderry, NH 03053 Bus. Tel. N,(603) 898-2407 Alt. Tel. No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ 15.00 (Signature of Owner or Agent) TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures A ove Swimming Pool grnd. ❑ rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat Total I otal No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers S ace/Area Heating KWMunicipal Local ❑ Connection ❑Other No. of Dryers HeatingDevices KW No. o No. -& Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No Hydro Massage Tubs No of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESXXNO ❑ ! have submitted valid proof of same to this office. YEM NO ❑ Faxed 7-18-01 If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE RR BOND ❑ OTHER❑ (Please Specify) National Grange Mutual Iris. Co. 3-11-02 (Expiration Date) Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAME Laroche Electrical, Inc. Final _ LIC. NO. Licensee Arthur W. Laroche, Jr. Signatur LIC. NO. MR 13 Address P.O. Box 482, Londonderry, NH 03053 Bus. Tel. N,(603) 898-2407 Alt. Tel. No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ 15.00 (Signature of Owner or Agent) October 4, 2010 Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 Dear Sirs, On Monday October 3 and Tuesday October 4, 2010, D.E. Small electrical contractors were working on the interior and exteriorb i,#,#hover. There was no permit visible. Being a reputable, local contractor, D.E. Small should abide by the rules of our building code. Diane McGarvey, the owner of 90 Lacy Street, has already been cited at least once for having work performed without a permit. In bringing this issue to your attention, I would like to remain anonymous. I hope you can have a talk with the homeowner and contractor. Betty Pogor 1� O, S'Lao '6�•No i`� 6� 'J - 6 �L O . 13 Town of North Andover BUILDING DEPARTMENT 10-15-10 RE: 90 Lacy St. I have talked to the rep. from Small Electric about the complaint from Ms. Pogor about 90 Lacy street permit issue and was told they replaced a switch, changed four spot lights (lamps only) about 1.5 hours total in the first week of October.. in which no permit is required per NEC Art. 80.17 (c) (1) enclosed document. Peter Murphy Electrical Inspector la)-�GX-Kx Community Development Division, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9545 Fax 978.688.9542 Web www.townofnorthandover.com 1 ANNEX H Annex H: Administration (H) Meetinks and Records. Meetings and records of the Board shall conform to the following: (1) Meetings of the Board shall be open to the public as required by law. (2) Records of meetings of the Board shall be available for review during normal business hours, as required by law. 80.17 Records and Reports. The authority having juris- diction shall retain records in accordance with (A) and (B). (A) Retention. The authority having jurisdiction shall keep a record of all electrical inspections, including the date of such inspections and a summary of any violations found to exist, the date of the services of notices, and a record of the final disposition of all violations. All required records shall be maintained until their usefulness has been served or as otherwise required by law. (B) Availability. A record of examinations, approvals, and variances granted shall be maintained by the authority hav- ing jurisdiction and shall be available for public review as prescribed by law during normal business hours. 80.19 Permits and Approvals. Permits and approvals shall conform to (A) through (H). (A) Application. (1) Activity authorized by a permit issued under this Code shall be conducted by the permittee or the permittee's agents or employees in compliance with all require- ments of this Code applicable thereto and in accor- dance with the approved plans and specifications. No permit issued under this Code shall be interpreted to justify a violation of any provision of this Code or any other applicable law or regulation. Any addition or al- teration of approved plans or specifications shall be approved in advance by the authority having jurisdic- tion, as evidenced by the issuance of a new or amended permit. (2) A copy of the permit shall be posted or otherwise readily accessible at each work site or carried by the permit holder as specified by the authority having jurisdiction. (B) Content. Permits shall be issued by the authority hav- ing jurisdiction and shall bear the name and signature of the authority having jurisdiction or that of the authority having jurisdiction's designated representative. In addition, the permit shall indicate the following: (1) Operation or activities for which the permit is issued (2) Address or location where the operation or activity is to be conducted (3) Name and address of the permittee 2008 Edition NATIONAL ELECTRICAL CODE (4) Permit number and date of issuance (5) Period of validity of the permit (6) Inspection requirements (C) Issuance of Permits. The authority having jurisdic- tion shall be authorized to establish and issue permits, cer- tificates, notices, and approvals, or orders pertaining to electrical safety hazards pursuant to 80.23, except that no permit shall be required to execute any of the classes of electrical work specified in the following: •(1) Installation or replacement of equipment such as lamps and of electric utilization equipment approved for con- nection to suitable permanently installed receptacles. Replacement of flush or snap switches, fuses, lamp sockets, and receptacles, and other minor maintenance and repair work, such as replacing worn cords and tightening connections on a wiring device (2) The process of manufacturing, testing, servicing, or re- pairing electrical equipment or apparatus (D) Annual Permits. In lieu of an individual permit for each installation or alteration, an annual permit shall, upon application, be issued to any person, firm, or corporation regularly employing one or more employees for the instal- lation, alteration, and maintenance of electrical equipment in or on buildings or premises owned or occupied by the applicant for the permit. Upon application, an electrical contractor as agent for the owner or tenant shall be issued an annual permit. The applicant shall keep records of all work done, and such records shall be transmitted periodi- cally to the Electrical Inspector. (E) Fees. Any political subdivision that has been provided for electrical inspection in accordance with the provisions of Article 80 may establish fees that shall be paid by the applicant for a permit before the permit is issued. (F) Inspection and Approvals. (1) Upon the completion of any installation of electrical equipment that has been made under a permit other than an annual permit, it shall be the duty of the person, firm, or corporation making the installation to notify the Electrical Inspector having jurisdiction, who shall inspect the work within a reasonable time. (2) Where the Inspector finds the installation to be in con- formity with the statutes of all applicable local ordi- nances and all rules and regulations, the Inspector shall issue to the person, firm, or corporation making the installation a certificate of approval, with duplicate copy for delivery to the owner, authorizing the connec- tion to the supply of electricity and shall send written notice of such authorization to the supplier of electric service. When a certificate of temporary approval is issued authorizing the connection of an installation, 70-781