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HomeMy WebLinkAboutMiscellaneous - 94 LYMAN ROAD 4/30/2018 (4)NORTH .ANDOVER BUHUNG DEPART I ENT 1600 Osgood Street North ARdOVer . • F • Tel: 978••698-9545 • . Fax: 978688-9542 .BUSINESSFORMFOR TOWN CLERK DAM NAME: 4,+4,kL, 64A,44-4-~ a �i Del vTv pA ADDPESS: ,ONMIDISTRICT: - TYPE OFBUSINE, 5S.� BUMI)ING LAYOUT PROVIDED.- YES ISD AVA_t LABLE PARKING SP .(�r. ' , ZONING BY LAW USAGE: '� �'EE NO 13LTILDIKG INSPECTOR SIGNA.TUPIE RUSMSS FORM FOR MWN CLERK r.�- • , 2.40 Bonze Occupation (1989132) .An accessory use conducted Wtbin a dwelling by a resident who -resides in the dwelling as his principal address, which is clearly secondary to the use. of the, -building for luring piuposes. Home occupations shall 'iftekide,-bu't not 'limited to the :following uses; personal services such as furnished by an artist or instzucior, but not occupation involved with motor vehicle xepwrs, beauty parlors, animal kennels, or the conduct of retail business, or the rmnufactariz g agoods, wbich impacts fide residential nature of the neighborhood;' 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) ,people may be employed it i -b hLoine occupation, one of whom shall be theowiier of the home occu anon- a -ad said dwelling, b. The use is carried on strictly within the principal building; e. There shall be no exterior alterations, accessory buildings, or display which are not custamaw with residential buildings; . �.., ;.. Y ,` \-x d. Not more than. iwent , five (25) percent of the existing gross floor area of <fbs � uell�Yag unit. so used, not to exceed one thousand (1000) square feet; is devoted to 'such use. In connectionwith such use, there is to be k`eptIo akk i hada, co nmoditi®d°or`prodi cls r iol� c i `ce beyond these limits; e. There w11 be no display of goods or wares visible from the sirci; f ,' Nei; batty or pxei�ise�: u� pied a]lMnoi:,be rendered ob�eciio rIo or�defrimeri#a1 to the residential cha>:acter of fhe neighborhood due tb the exterior appearance, emissiozi of odor, gas, smoke, dusk noise; disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no featur6s of dosis not cust6maq id buildings for'fbe denfial " Use. i a Dab 3 This certifies that.. P...ij 'P.. has permission to perform ..... .................... plumbing in the buildings of .... A'?e..................... at ..... l ..`'Y1G.. , , ... , North Andover, Mass. Fel,. ;1 : 7 ... Lic. No.).31-N .. H ................. .. . PLUMBING INSPECTOR Check # /I(Acl FLOOR / AREA DRAIN il�;!ilt I�il�'::It:�':�I• ' •' � Il>>>>l/'��;�:� I�'�_i�'Il� Il»>>>f`� I•';Il>>>>><"! • _- _. - -- — - --- ---- ----------- JAMNAL ASHING MACHINE• • ER HEATER ALL TYPES ��mwiipm an �i'm 11111111114 .: � �� �; � � Ali l• :�, � � ��; I have a current liabilityinsurance policy or Its substantial equivalent which meets the requirements of VOL CIL 142. YES El NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW '� LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMtv'iiY } � BOND tCNER'S INSURANCE WAVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the iassachusetts General Laws, and that my signature on this pennit application waives Uric requirement. CHECK ONE ONLY: AGENT SIGNATURE OF OWNER OR AGENT . hereby cw* that all of the details and information I have submitted or entered regarding this application are to the best of my lain—...j. and that all plumbing work and 'installation performed under the permit issued for this application nn11 be in pli all ertin sion of the AMassadwsits State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME PhOliP d Durfee LICENSE # 13774 SIGNATURE K) MP(1 JP0 CORPORATION [1#PARTNERSHIP[j#=LLC# 152 COMPANY NAME Plumbing & Heating LLC I ADDRESS E A Hunlinglon AVE CRY ut .Yarmouth�i- STATE ZIP 2664 — PEEL 8419 3078 _ ) IIID IIY-�li i���®�II�YY� Oil FAX &2%4%92 ] CELL 01-8004 EMAIL hii&durfeeplumbing.com /. .� ,���►� .rem �� �� t, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Inveshgadons 1 Congress Street; Suite 100 Boston, MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bb Name (Business/organization/ladividual): k R� M o I Ma-hw (Ir'l Address: 1, A 1'1 A k VIA :"G. Phone #: Are you an employer? -Check the appropriate box: l . bL1 I am a employer with ill _ 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. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insurance.$ required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] + 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. [v{Remodeling 3. [] Demolition 9. 0 Building addition .. 14.❑ Electrical repairs or additions 11. VAUmbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #t mint also fill out the section below showing their workers' contperisation policy information. t Homeowners who submit this affidavit indicating trey are doing all work and then hire outside contractors must submit a new affidavit indicating such: 'Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I ain an employer that is providing workers' compensation insurance for my employees: Below is the policy and job.site information. . t _f /^ 1 ,#- • - Insurance Company Name: Policy # or Self -ins. Lie. #: -76Q`�F�� ��j. Expiration Date:`_ Job Site Address:afYlQf'1 {�� City/Statc/Zip:h Anduet 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 Offtee of Investigations of the DIA for insurance coverage verification I do hereby cerci jl the ai and enaldes qjfpeirjury that the information provided above is true and correcL Phone #: Yom/ y 4 C1 - 3070 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 #• Division of Professional Licensure: License Search �• The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name:PHILLIP J. DURFEE DENNIS, MA ..This Licensee has additional Licenses, click here to view them."" Licensing Board: PLUMBERS Et GASFITTERS License Type: MASTER PLUMBER License Number: 13774 Status: CURRENT Expiration Date: 5/1/2014 Issue Date: 4/12/2005 Exam Date: 3/5/2005 School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Wednesday, May 15, 2013 at 9:52:12 AM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes More Site Policies Contact Us http://license.reg. state.ma.uslpubLiclpubLicenseQ.asp?board_code=PL&type class=_M&1... 5/15/2013 Date .1Y.-40. &Y.-401377.. .... ....... .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that A z /? .... ...... t— le". . /IX .................... ....................... has permission to perform ..... .....G4 1! ...................... wiring in the building of . ........................................ at ...�tV "n ........................................ North Andover, Mass. Fee .1. .......... Lic. No.'.C�.. �' ex. ........... - PLE CA�L INSP Check # 7603 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. —2,� o 3 Occupancy and Fee Checked tev. 1/07] (�paVp h�anlr� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code EC), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: V -04S op City or Town of: NORTH ANDOVER To the pecto ofMires: By this application the undersigned give notice of his or her intention to perform the electrical work described below. Location (Street & Number) (7L/ 2-V Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No 4 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /00 Ampsl 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: L) / No. of Recessed Luminaires -- No. of Ceil: Susp. (Paddle) Fans auum inuy ue wutvea vy me inspector oj wires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In ❑ rnd. rnd. o. o mergency ig g Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiatingTotaDevices No. of Ranges No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of Si s Ballasts . Sectio oyyf Devicmes or E uivalent Data N of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: -Arta additional detail tf desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) 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 coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEXBOND F1 OTHER E] (Specify:) I certify, under the ins and peva tie of perjury, that the information applic true and complete. FIRM NAME: 2 ' ®I �0- LIC. NO.: 64�1 Licensee: Signature LIC. NO.: (If applicable, enter "ex t " in a license numbe line.) Bus. Tel. No.: 222-45/5-2 26 Address: c� v".ti Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security wo requires Department of Public Safety "S" Li nse: 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 r Signature Telephone No. PERMIT FEE: $ S 41 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 Please Print Legibly Name (Business/Organization/individual):_Ui41 o -,L LAV b 1 & C lee IZ j C4 Address: A 13,vk °2 '�) q C City/State/Zip ! o k,,-, /1 Q ick ytt Phone #:. (? P — /E - % 26 Z- Are you an employer? Check the appropriate box: 1.2\I am a employer with 3 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub -contractors have 8. [] Demolition working for mein any capacity. [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its g, El Building addition required.] officers have exercised their eP 10 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No -workers' comp. c. 1.52, § I (4),' and we have no 12.(] Roof repairs insurance required.] t employees. [No workers' 13.F1 Omer comp. insurance required..] MlY nppucanc roar MUCKS oox F I must also fill out the section below showing their workers' compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their woricers' comp. policy information. I ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. ; Insurance Company Name: ,5 L_ Policy # or Self -ins. Lie. #: 6/- L, 22 Sar -7'626 D _ Expiration Date: Job Site Addres-7sy- City/State/Zip: r? 0,� Attach a copy of the wo kers' 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 advis t a copy of this statement may be forwarded to the Office of Investigations of the DIA for insixifnee cove venfi ion. I do hereby cert MME of perjury that the information provided abovg 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. 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 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 tr►aintenance,;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 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, nofthe 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 numberlisted below. Self-insured companies should enter their Self-insurance license number on the appropriate tine, 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 evenhhe 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 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 Ufrice 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 -OS www.mass.gov/dia