HomeMy WebLinkAboutMiscellaneous - Exception (712)0
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Location
No. /a 9
Date
TOWN OF NORTH ANDOVER
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number Date: January 15 2008
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 595 Chickeringz Road
MAY BE OCCUPIED AS Day Spa Commercial IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: The Santo Mangano Trust
595 Chickering Rd
North Andover Ma 01845
Building Inspector
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Date....
.......................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4
This certifies that ....... '1. ... r--.... ; .....: r ....... ...�e -4 .
...................... ��-
has permission to perform -�`-'
................................._:.......-...... ............... ...............
wiring in the building of ........ :�1 :tt1 . ��='��
..............................................................
at.4�a2,�.......t...:..........(�:............................... . North Andover,.Mass.
Fee . ! .......... Lic. No�. /9.F ............. :...........
ELEC�RI�AIIIISPE OR
Check #
766
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked 4�6.
BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/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: / -, q— -o 7
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) J�� �,,�iL'�(e/
Owner or Tenant y S
Owner's Address
7 /0/4
-5tP%-2 Telephone No.g,/ft -6
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building .&, S"g%Q,y 124�j ,$' Utility Authorization No.
Existing Service' Amps /igd Ls Volts Overhead Undgrd ❑'� No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity �C) 3 .. Co /4A -7a
Location and Nature of Proposed Electrical Work: f.l "j A.;AI'I"o otkL
Completion of the following table may be waived by the Inspector of Wires_
No. of Recessed Luminaires 30
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above In
Swimming Pool rnd. 1:1rnd. ❑
o. o mergency Lighting
Batter Units
No. of Receptacle Outlets 10
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches 9 O
No. of Gas Burners
No. of Detection an
InitiatingDevices
No. of Ranges
No. of Air Cond. Tons �'
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
s
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. o
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications firing:
No. of Devices or Equivalent
OTHER:
V Attach additional detail if desired, or as required by the Inspector of 17"ires.
Estimated Value of Electrical Work: �ej( Co, 00 (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 cover e is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: S"io LIC. NO.: 7l1 16
Licensee: AM ,g.011 Signature''�^ LIC. NO.:
(If applicable enter "exem t" in the license number li ) n — T
�� �,,,l(�� Bus. Tel. No.: %� S" r 7
Address: ;13 h -OC 3n. `5 - � -t'�I-li►�i-�+� jf '� -,+ 0)7,L1y Alt. Tel. No.:7//-&6- -753"7
*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 agent.
Owner/Agent [PERMIT FEE: $
Signature Telephone No.
I
{` The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street :
Boston, MA 02111
s� www. mass.gov/di a
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
]
Address:
City/State/Zip: �'l>.+2' � ten- 11111L 6f ?4� Phone #: �'� -7)
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
Jnpfnyees (full and/or part-time).*
2. Er I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance 5. ❑
required.]
3. ❑ 1 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet. $
These sub -contractors have
workers' comp. insurance.
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. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
1 i.❑ Plumbing repairs or additions
12.❑ Roof repairs
l3.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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:
Policy # or Self -ins. Lic. #:
Job Site Address:
Expiration Date:
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 ceiAify under the pains and penalties ofperjury that the information provided above is true and correct.
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
AN
4
"0 PT :1�a TOWN O NO, H ANDOVER
PERMIT FOR PLUMBING
,SSACMUSE� j
This certifies that .•!�'`"� ...... ......... ..... .
has permission to perform-.
plumbing in the buildings of ...... ......
at .. � I .... ......., .. r.. - ..... , North Andover, Mass.
.G..
Fee..... Lic. No. ,`%/. ............
PL.UMB1 G INSPECTOR
Check # Z V v
7403
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASS
ACHUSETTS
Building Location] C ���r�j t'� Owners Name Date
Permit # '
Amount --17/
Type of Occupancy A V 5-
New ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes 1111" No ❑
FIXTURES
(Print or type) Check one: Certificate
Installing Company Name"p�� a ,(,, L �L dnt d3 ! -r' i�Ht � J ❑ Corp.
Address 116, 3Z . a
L CL, e c t"� � - 0315"."5 Partner.'
Business Telephone 601. �3,yjZ . D(2-1- LFirm/Co.
Name of Licensed Plumber�� , 6%
Insurance Coverage: Indicate theance coverage by checking the appropriate box:
type of insura
Liability insurance policy 0 Other type of indemnity type
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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
r
By: b1gnaWM ot Licenseaum er
Type of Plumbing License
Title --?.All? 9 C.
City/Town License um er Master ❑ Journeyman ❑
APPROVED (OFFICE USE ONLY
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(Print or type) Check one: Certificate
Installing Company Name"p�� a ,(,, L �L dnt d3 ! -r' i�Ht � J ❑ Corp.
Address 116, 3Z . a
L CL, e c t"� � - 0315"."5 Partner.'
Business Telephone 601. �3,yjZ . D(2-1- LFirm/Co.
Name of Licensed Plumber�� , 6%
Insurance Coverage: Indicate theance coverage by checking the appropriate box:
type of insura
Liability insurance policy 0 Other type of indemnity type
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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
r
By: b1gnaWM ot Licenseaum er
Type of Plumbing License
Title --?.All? 9 C.
City/Town License um er Master ❑ Journeyman ❑
APPROVED (OFFICE USE ONLY
Date ... ..`.. .7..... .
NORTH
3? �`6.641 0 0TOWN OF NORTH ANDOVER
FO P
# PERMIT FOR GAS INSTALLATION
This certifies that ..... P. 4 . ?'.e'.. l......
r
has permission for gas installation ..........
in the buildings of ...0.. f; !..(... . � w /� . ✓................... .
at.7 ....... North Andover, Mass.
Fee..C'/ Lic. No.,?'!.9.7.x. ' ��-AS
INSPECTOR
Check #
6234
r
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTrnNG
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
-57sS- C- le
&I✓ �' �"® s4 e-oOwner's Name
New Renovation Replacement Plans Submitted
Date
Permit # t<L' 3
Amount S
(Print or type �i
Name o,, ' G 7-/-/Fbfi� Check one: Certificate Installing Company
11 Corp.
Address `s �1egt-,f /";P. 0je6-s-
Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE Check on
I have a current liability Insurance p licy or it's substantial equivalent. Yes No
D
If you have checked Les, please i nate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond D
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:
Signature of Owner or Owner's Agent Owner D Agent D
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Ch 42-Pf the General Laws.
By:
Title
City/Town
OV ED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas"Pitter
DPlumber
DGas Fitter (cense NUM Der
DMaster
13 Journeyman
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BASEM ENT
1ST. FLOOR
2ND. FLOGR
3R D. FLOG R
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type �i
Name o,, ' G 7-/-/Fbfi� Check one: Certificate Installing Company
11 Corp.
Address `s �1egt-,f /";P. 0je6-s-
Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber'or Gas Fitter
INSURANCE COVERAGE Check on
I have a current liability Insurance p licy or it's substantial equivalent. Yes No
D
If you have checked Les, please i nate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity D Bond D
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:
Signature of Owner or Owner's Agent Owner D Agent D
I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Ch 42-Pf the General Laws.
By:
Title
City/Town
OV ED (OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas"Pitter
DPlumber
DGas Fitter (cense NUM Der
DMaster
13 Journeyman