HomeMy WebLinkAboutMiscellaneous - Peters StreetDate ........ ........
..................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... Leot,-ARAL�eAWA
...........................................................
-rform.
has permission to pe .................. ............
winng in the buildin ..... . ...... ........
............ .... ........ ...
.. ......
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at.k62— Re, 4 g of Andover, Mass.
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Fee ...... 141;--o ...... TUC. No. .. . . ....... _;�
CAL SP
Check #
12394
I Commonwealth of Massachusetts Office Use Only
\ ? 7
Department of Fire Services Permit No.
30ARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK#
Occupancy & Fee Checked
(Rev. 11 /99) (leave blan�)-
PPI Ir_ATIr)KI r)D Dr-:DhAIT Tr) DC:D nDhA CA l=:t--rE:)Ir-A
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All work to be performed in accordance with the Massachusetts Electrical Code (MEG ), 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) up—k DATE May 29, 2014
City or Town of North Andover 4.11 '14, To the Inspector of Wires:
A ZZ2111111M
By this applicationthe un-dersigned gives notice of his or he7intention to perform thelwellectriCal work descdbed below.
Location(Street & Number) 102 Peters St
Owner or Tenant Dundee Properties BUILDING CONTRACTOR
Owners Address 30 Glenn St CONTRACTORS ADDRESS
Lawrence, Ma
Is this permit in conjunction with a building permit
Purpose of Building Commercial
Yes [j] No F-1 Building Permit no.
Existing Service
2 0 0 Amps 120/208
Volts
single PHASE
New Service
Amps
Volts
PHASE
Utility Authorization no.
No. of Ceil.-Susp. (Paddle ) Fans
Overhead
Undgrd
No. of Meters Three
Mast Service
Syphone
N
Overhead
Undgrd
No. of Meters
Mast Service
Syphone
R
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Install wiring for tenant fit up on right side
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle ) Fans
No. of Transformers Total
KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators Total
I
KVA
�o. of Lighting Fixtures
Swimming Pool Above In-
gmd F1 gmd
No. of Emergency Lighting Battery Units
o. of Receptacle Outlets
No. of Oil Burners FHW FHA
FIRE ALARMS No. of Zones
No. of Switches
No. of Gas Burners FHW FHA
No. of Detection and Initiating Devices.
No. of Ranges
No. of Air Conditioners Total
No. of Alerting Devices.
Tons
No. of Waste Disposers
Heat Pump
N u m.b.e. r ...
.. ..... . . . I
.. ....
....... T2ns ......
KW
I ....................
No. of Self Contained Detection Alerting
T tals:
Devices.
No. of Dishwashers
Space / Area Heating KW
Local Municipal Other
Connection M Connection
No. of Dryers KW
Heating Appliances KW
Security S7stems:
No. of De4i9es or Equivalent
No. of Water KW
No. of Signs No. of
Data Wiring:
Heaters
Ballast's
No. of Devices or Equivalent
No. Hydro Massage Tubs
No. of Motors Total HP
lNo.of
Telecommunications Wiring:
Devices or Equvalent
Estimated Value of Electrical Work $
( When required by municipal policy. )
Work to Start: May 29, 2014 Inspection to be requested in accordance with MEC Rule 10, and
I certify, under the pains and penalties of perjury, that the information on this application J15�ue and comDlete
FIRM NAME Leonard Electric, Inc.
Licensee
LIC.NO.
(Expiration Date)
A10638
Address 154 Fletcher Street, Lowell, Ma. 01854 Bus. Tel. No. ( 978 ) 937-8620
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 EJ Agent F-1
(please check one)
(Signature of Owner or Agent) Telephone No. PERMIT FEE $
OTHER:
Attach additional detail if desired, or as required by the Inspector of wires.
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 [0 BOND [] OTHER F_�
(Specify:)
Estimated Value of Electrical Work $
( When required by municipal policy. )
Work to Start: May 29, 2014 Inspection to be requested in accordance with MEC Rule 10, and
I certify, under the pains and penalties of perjury, that the information on this application J15�ue and comDlete
FIRM NAME Leonard Electric, Inc.
Licensee
LIC.NO.
(Expiration Date)
A10638
Address 154 Fletcher Street, Lowell, Ma. 01854 Bus. Tel. No. ( 978 ) 937-8620
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 EJ Agent F-1
(please check one)
(Signature of Owner or Agent) Telephone No. PERMIT FEE $
���1 6"Z��`��
;W
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lellibly
Name (Business/organization/Individual): Leonard Electric, Inc.
Address: 154 Fletcher Street
Citv/State/Zin- Lowell, MA 01854
Phone#: 978 937 8620
Are you an employer? Check the appropriate box:
1. 1 am a employer with 20
4. E] I am a general contractor and I
employees (full and/Wp_art-time).*
have hired the sub -contractors
2. 1 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.1
required.]
5. We are a corporation and its
3. El I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. E] New construction
7. El Remodeling
8. [1 Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
I I - El Plumbing repairs or additions
12.[] Roof repairs
13 -El 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.
lContractors 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 am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name: SELECTIVE INS. OF S. CAROLINA
Policy # or Self -ins. Lic. #:WC799386600
Expiration Date: 6/30/2014
Job Site Address: le2,
City/State/Zip:_,Z/.
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��.Kcla_d_v)ed that a copy of this statement may be forwarded to the Office of
Investigations of the insurance cpverage y-E-xification.
I doll ereb� �re ainsand a gte!:Uury that the information provided above is true and correct.
Y
Official use only. Do not write in this area, to be completed by city or town official,
City or Town:
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6. Other
Contact Person:
Permit/License #
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #:
";4
SUES T��,.YOLLOWI G -A
R
MA�Tg.. Ej-ECTR I C I
D ELECTR I
L
154 F L MME."; Ri'--'STR 2r
0 1854-41
i063q
27410
�11 12
NORTH ANDOVER BUILDING DEPARTMENT
1600 Osgood Street
North Andover
Tel: 978-688-9545
Fax: 978-688-9542
BUSINESS FORM FOR TOWN CLERK
DATP,:. , � Z (z // y
A A liv)
ADDRESS: Z,-) 2—.
ZONINGDISTRICT:
TYPEOF13USINESS., 1�ebl
BUILDING LAYOUT PROVIDED: rYES-) N . 0
AVAILABLE PARKING SPACES:
ZONING BYLAW USAGE: YES NO
BUILDING INSP'ECTOR. SIGNATUPIE
13U,%NESS FORM POP TOWN CLERK
1�;_
2.40 Home Occupation (1989/32)
An accessory use, conducted within a dwelling by a resident who resides in the dwelling as his principal
address, NvMch is clearly 8econdary to the, use - of the. -building. for �Ang purposes. Home occupations shall
incEdo, -bit not Imited to the following uses; personal services such as furnished by an artist or instructor,
but not Occupation involved wilh motor vehicle. repairs, beality parlors, animal kennels, or the, conduct of
retail business, or the manufacftuirig o�goods, Which impacts the residential nature of the neighborhood,
4. For use ' of a dwelling in @ny residential district or multi-f4mily district for a home occup6tion, the,
following conditions shall apply:
a. Not more than a total of three (3) people may be. employed in the home Occupation, one of
whom shall be theOmier of thd h6me Occupation and residing ift -said divelling,
b. The use is carried on strictly within the principal building;
c. There shall be no exterior alterations, accessory buildiugs, or display which are not customary
with residential buildings;
d. Not more than twmfy-five (25) percent of the existing gross floor area of the dAve,11mg unit
so used, not to exceed one thousand (1000) square fed, is devoted to'such use. J11
comectionwith.
such use, thera is to be kept no stock in trade, commodities or products which occupy space
beyond these limits;
0. There will be no display of go6ds or wares visible from the. street;
f The buildmg: or premises occupied shall not be rendered objectionable or detrimental to the
residential character of the neighborhood due to the exterior appearance, emission of odor,
gas, smoke, dust, noise, disturbance, or in any other way become objectionable, or
deftinerital to any residential use vithk the. neighborhood,
g. Aky such building shall include no features of design not cust6mary in buildings for residential
use.
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