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HomeMy WebLinkAboutMiscellaneous - Suite 3051 rp CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Permit # 566 (4129/09) Date: lime 12009 THIS CERTIFIES THAT Z THE BUILDING LOCATED ON 451 Andover St MAY BE OCCUPIED AS Blood Laboratory -Tenant Fit un ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Winchester Hospital 451 Andover St North Andover MA 01845 Building Inspector 9 a a co Q co 0 w Z m fl. O CO) � C CD cm CO2 -0 O CD�— H CD .g m ca CD CD co C ~ � O � 0 Q CD L- ewa o a M: CDQ CO2 C c CIOc v CL c 03 C Z CD C3 CL L.i y R C C C c C/O m C C N O C V C� PQ a� v a a w cli Ci N N w z Q o LE cn w° a°' C w ° W. w°' IO w w°' w coy cn cn 9 a a co Q co 0 w Z m fl. 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THIS- CERTIFIES- THAVY TIRE BUILDING DING LOCATED- ON 45-1 Andover Street, Suite -305- North Andover; MA 01-845 Priority Pain. Relief Therapy MAY HE OCCUPIED AS massage therapist_IN ACCORDANCE WITH HE T.- 1-1 - PROVISIONS- OF THE MA- $$A CJIUSETT$-:5TATE BVILDIN CODE AND $,VCH OTHER REGULATIONS AS MAYAPPLY. Certificate Issued to: /% 00 FCC: 109.:RF- Receipt: 24262 Helen Phillips 42-ParkAvenue. Salem, N.H. 03079. Building Inspector 7 s �.� Location r No. r Date • �� • + _. ,,o—zh . TOWN OF NORTH ANDOVER O e ` ' 00 Certificate of Occupancy $ ;�s'••a°' Eta' s.4cNus Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Z �- Check #24, Building Inspector M008Artlstic Checks 1-800-224-7621 www.ar8sticcheeks.— ' f -I-lelevi Pkillips�FI53Sh elOw Ch -7 113 036,91 42 Pari, 'Ave. Frau rolecho Y= Sol.-, J +-1 03079 nAL 10 Ike $ /tea oa 4 rj ----7 L/'� Contai secmiry [ I D0v� 1�.r5 8 Fe a ..I.rlures. Oelails i LJ on Back TD BANK 8 MASSACHUSETTS Y C/ /1 r C1 �7 Q � �evtio i'�,(�j(2' � ror 11:21i370545i: 824297738411' 0369 @Cheri Blem, Licensed by WIN Apple Licensing o Cl TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: CG() Date Received Date Issued: r I t IWORTANT: Applicant must complete all items on this page, �/ LOCATION a� 9 (. r�tDt�fG'l At c^IO v er14 A 6P Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Alteration No. of units- ❑ Repair, replacement ❑ Assessory Bldg ❑ Demolition ❑ Other Non- Residential r©S ptic Well - ,�+ ' ifloodp-la�irRia-��iiWetland_s_ X HI` 1 n � DES CRi? T ION UP WORK TO i E PER,rO_RAMD: v\i ❑ Industrial ❑ Commercial ❑ Others: 7. �WatershedaDistrict� r Ne (Identification Please Type or Print Clearly) OWNER: Name:__ �'1 ��,(d � � i 1142 S Phone Address: 14A 19b -P' CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERpM�IT' $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.1 Total Project Cost: $ ( FEE: $ �� Check No.: Receipt No.: ,WXX 2 NOTE: Persons contr cting with /unregisiehed ontractors do not have access ------to the guaYanty fund CERTMCA,TE GY ]USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit -Number- 616=201-1 —Date: June 1-7, 201-1 TRIS- CERTIFIES= TIU-T THE BUILDING LOCATED ON 451 Andover Street, Suite -305- North- Andover, MA- 01845 Priority Pain Relief Therapy MAY BE OCCUPIED AS massage thMaRist IN ACCORDANCE WITH THE PROVISIONS. OF THE MA $$ACHU$ETTS- STATE BUILDING, CODE AND SUCH OTHER- REGULATIONS THERREGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 Receipt: 24262 Helen Phillips 42 - Perk Avenue . Salem, N.H. 03079 - Building Inspector Date..... �.......`.'.....��....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ;... ......... l-:�:................................................. has permission to perform ......`. `' �- l ........................................................... wiring in the building of ....... �- z< at ..�%`? ....................................... �-...... f, .. y'' North/Andover, Mass. ..... ..... Fee.,? ..: Lic. No .............. . ....................................... .. . .. ... ELECTRICAL INSPECTOR Check # 87 -�:i Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 69z 3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked /�-- [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (Iv�EC), 27 CMR 12.00 (PLEASE PRINTMA ININK OR TYPE ALL INFORM -4 Date: 7 City or Town of: NORTH ANDOVER To the Inspe or f Wires: By this application the undersigned notice his gives of or her intention to perform the electrical work described below. Location (Street & Number) ( nd 6 _ 66 Owner or Tenant Y Owner's Address Q Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No IN (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd 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: Com letiion of the ollowin table may be waived by the Inspector of Wires. No. of Recessed Lumflnaires No. of Ceil: Susp. (Paddle) Fans o. of Total No. of Luminaire Outlets. No. of Hot Tubs Transformers KVA Generators KVA No. of Luminaires Swimming Pool Above ❑ Iu- d• o. o mergency ig g —, rnd. No. of Receptacle Outlets No. of Oil Burners Batte Units FIRE ALARMS No of Zones No. of Switches No. of Gas Burners No..of Detection and No. of Ranges No. of Air Cond. Total Tons Initiatin Devices No. of Alerting Devices No. of Waste Disposers Heat Pump Number ons KW _ No. of Self -Contained Totals: ,s No. of Dishwashers Space/Area Heating KW Detection/Alerting Devices Local ❑ Municipal ❑ Other No. of Dryers Heating Appliances KW No. WaterNo. Connection Security Systems:* No. Devices of of Heaters KW No. of of or E uivalent Data Wiring: Si grits Ballasts No. Hydromassage Bath No. of Motors Total gp No. of Devices or E uivalent-Z Telecommunications Wiring: OTHER: No. of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. (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: INSURANCE BOND ❑ OTHER ❑ (Spec' I cerci under th'') ITY, pains nd penalties of perjury, that the informatio this is 'on is true and complete. FIRM NAME • G LIC. NO.: Licensee: G, Signature (If applicable, enter "exempt " in the licnse num r line.), LIC. NO.: Address: / lw� u(� , Q M Z l�U Bus. TeL No.: *Per M.G.L c 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt. L cl. No�—����a0 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 Washington Street Boston, MA 02111 www.nzas..gov/dia . Workers' Compensation 1witrance Affidavit: Builders/Contractors/Eiectricians/Pfnmbers nnliennt T..f.........a:,... Nanie (Business/organization/individual): Are you an employer? Cheek.the appropriate box: I. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (fill/ and/or part-time).* 2. L] I am a.sole proprietor or have hired the sub -contractors Iiste;d partner- on the attached sheet t ship and have no employees These sub -contractors have working for mein any capacity,workers' [No workers' comp, insurance comp. insurance. 5. ❑ We are 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' comp. insurance required_] Type of project (required): 6.. ❑ New construction 7. ❑ Remodeling S. Q Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 -ED Plumbing repairs or additions 12.❑ Roof repairs 13.0.Other V -­ - +.,.._, naso n« out me section below showirig 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. 4contractors that check this box must attached an additional sheet showing the name of the sub•contnictms and their workers' comp. Policy information. P i3 i fo an ion,loy that is proviamg.workers' compensation h2surance for my employees: Below is the policy and job site information.. .11 Insurance Company Name: ' Policy # or Self -ins. Lie. #: Expiration Dater 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 true and correct Si Lure: Date: Phone #: Official ase only. Do not write in this area, to be complexed 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 6. Other . Plumbing Inspector Contact Person: Phone #• ALDAROLA DESIGN ASSOCIATE S, PC Architecture ❑ Interior Design May 6, 2009 To: Mr. Gerald Brown Inspector of Buildings Town of North Andover North Andover, MA 01845 Re: Renovations to 451 Andover Street Suite 305 North Andover, MA Dear Mr. Brown, To the best of my knowledge, belief and understanding, the work performed at the above noted location is complete and in accordance with the approved construction documents dated 4/8/09. If you have any questions, please do not hesitate to call. VFEZ" M�nr®r7dA� ?�W-. 1121 Robby Roberston Cc: Joseph Caldarola File 0 4 Birch Street, Derry, NH 03038 (603) 432-8404 (Fax) 432-2706 No. 7728 LONDONDERRY \\ NH Date. z� h .l TOWN OF NORTH ANDOVER ,(, l PERMIT FOR PLUMBING This certifies that .. �'`!. ` ... ....................... .................... has permission to perform ... � .................... � plumbing in the buildings of . at...yl l .%���� ..................... .A .. ,..,North Andover, Mass. Fee. �� .... Lic. No.. �.2 i 7. ........... �'..... . PLUMBING INSPECTOR Check # ' C L / MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO OO PLUMBING (Print or T ) an Mae._ oat. Location ' 404 Name New p Renovation Replacement p Plans Submittel: Yes ❑ NO(3 N FIXTURES ZY O y < F > y y Z y=O= y < c� Z N W W a n 0 Q D 1- W W f. < N X< = y y n < y < a y < rr V Z W y H W } J W 0 p J y 3= t'z OC W = 0 W h W X y O C O V Y W o < 7C = Y J fD y O O J SUB—BS MT. I BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR _ eTHFLOOR 7TH FLOOR 8TH FLOOR InataflkV Company Name Address S 2- R20& Business Telephone ZZL C9C<S` --3Z Name of licensed Plumber bog, Check one: p Corp. 2rm/Co. ershlp IMIUt+' KUlt COVERAGE; Chdc have a current liability insurance Icy or its substardial equivalent. Yes No p K you have checked vim, pleaae scale the type coverage by checking the appropriate box A ItablRy insurance policy Other type of Indemnity O Bond ❑ Certificate OWNER'S INSURANCE WAIVER: i am aware that the ikensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my algnature on this pem'lt application waives this requirement. Check one: 1116-n-Aus Of Omw or s Ac O r p Agent ❑ hereby certtty that aA of the details and Information I have submltti is and that all f wrkkp work and Indallafts parformd 6 Own Provisions of a Massachusetts State Pkrmbkq Coda and 8y TitN Gtyno" AP"XWEO (OFFICE USE ONLY) nry Ion %* beand an ato eat, Ace rNth allbest TYPOType of Plurnbkp Ucanse: Master Journeyman ❑ FIXTURES ZY O Z < F > y = F y=O= y Z c� Z Z W a n 0 V < W f. < y y X< = Z D y n < W O y Z < a d a < rr 3 X O {� W J y Cr a J p p J y 3= t'z I 0 y 0 W y a z c< W i 3= O V Y W o Business Telephone ZZL C9C<S` --3Z Name of licensed Plumber bog, Check one: p Corp. 2rm/Co. ershlp IMIUt+' KUlt COVERAGE; Chdc have a current liability insurance Icy or its substardial equivalent. Yes No p K you have checked vim, pleaae scale the type coverage by checking the appropriate box A ItablRy insurance policy Other type of Indemnity O Bond ❑ Certificate OWNER'S INSURANCE WAIVER: i am aware that the ikensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws. and that my algnature on this pem'lt application waives this requirement. Check one: 1116-n-Aus Of Omw or s Ac O r p Agent ❑ hereby certtty that aA of the details and Information I have submltti is and that all f wrkkp work and Indallafts parformd 6 Own Provisions of a Massachusetts State Pkrmbkq Coda and 8y TitN Gtyno" AP"XWEO (OFFICE USE ONLY) nry Ion %* beand an ato eat, Ace rNth allbest TYPOType of Plurnbkp Ucanse: Master Journeyman ❑ LO Date ......`..�..... ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING J � M6 �. This certifies that .................................................. ................... has permission to perform......�` wiring in the building of/¢.:.'.� �� �.. ................ ............. .............. ................... 36)5- at oSat .... Z1.... ..., DDUj e0 ...... :� r...... , North Andover, Mass. D � Fee.... ......... EX. N u.:Z..?� 1. - '........ ELECCRICALINSPECTOR / Check # c�d 3 x 2) N Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 07 By 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) �� )PY-1)r li� LJ --1 , �— Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building P W IC V'SLO Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets FNo.of witches anges aste Disposers Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ 3 No. of Ceil.-Susp. (Paddle) F No. of Hot Tubs Swimming Pool Above ❑ d. No. of Oil Burners No. of Gas Burners No. of Air Cond. Tot Ton No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Appliances No. of Water No. of Heaters' No. of Si s Ballast No. Hydromassage Bathtubs No. of Motors Total OTHER: No. of Meters No, of Meters t,�R V I( iAf be waived by the Inspector of Wires, anS iNu. ui Total Transformers KVA Generators KVA In- ❑mergency Ig g rnd. BatteryUnits FIRE ALARMS No. of %nes No. of Detection and InitiatingDevices asl No. of Alerting Devices KW No. of Self -Contained -� - - Detection/Alerting Devices Local ❑ Municipal Connection ❑ Other ICS' Security Systems:* No. of Devices or Equi valent Data Wiring: s No. of Devices or Equivalent HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail zf desired, or as required by the Inspector of Wires. Estimated Value of ElectricOa 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 cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Spec I certify, under the pains and penalties er'u that the information on this application is true and complete. fP t1', FIRM NAME: Licensee: LIC. NO.: �•(/ Signature LIC. NO.: (Ifapplicable, enter "exempt " in the li� a nu b r h Address: e , Bus. Tel. No.: - c7, *Per M.G.L c. 147, s. 57-61, security work requires D Alt. Tel. No.: 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 Signature Telephone No. PERMIT FEE. $ Attach additional detail zf desired, or as required by the Inspector of Wires. Estimated Value of ElectricOa 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 cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Spec I certify, under the pains and penalties er'u that the information on this application is true and complete. fP t1', FIRM NAME: Licensee: LIC. NO.: �•(/ Signature LIC. NO.: (Ifapplicable, enter "exempt " in the li� a nu b r h Address: e , Bus. Tel. No.: - c7, *Per M.G.L c. 147, s. 57-61, security work requires D Alt. Tel. No.: 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 Signature Telephone No. PERMIT FEE. $ 5 4 `s1IMa 1; J , The Commonwealth of Massachusetts Department of Industria! Accidents Office of Investigations 600 Tirashington Street Boston, MA 02111 r I www.nwss gov/dia . Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apj2licant Information Please Print Leably Name (Business/Organization/Individual): Are mployer? Check the appropriate box: 1. ❑mployer with 4. ❑ I am a general contractor and I Type of project (required): ees (full and/or part-time).* 2shipand have hired the sub -contractors 6. ❑ New construction ole proprietor or partner_ listed on the attached sheet. � 7• ❑ Remodeling have no employees These suh-contractors have 8. ❑ Demolition working for me .in any capacity, [No workers' comp. insurance workers' comp. insurance. 5. F7 We are a corporation and its 9' ❑ Building addition required-) 3. F1I am a homeowner doing officershave exercised their 10.❑ Electrical repairs or additions all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No•workers' comp, c. 1.52, § 1(4), and we have no 12Roof repairsinsurance required.] t employees. [No workers' l3.❑.Other comp. insurance required_) - •--••• -w• mux n t muse luso 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 conmwtom must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policy information. I am an employer that is. provafing:workers, compensation Insurance for my employees; B information elow is the Policy and job srte Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage' as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a - fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert of perjury that the information provided above is tct true and correct. Date: /'c�(� -0 / Of, iciat 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 #: