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Home My WebLink AboutMiscellaneous - Suite 340QN) CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 425-2012 Date: DECEMBER 14, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 451 ANDOVER ST, SUITE, 340 North Andover, MA 01845 AMANDA BERNARD=ESTHETICIAN MAY BE OCCUPIED AS TENANT FIT -UP AND HANDICAP BATH IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: 100.00 PREVIOUSLY PAID Receipt: .24827 NAOP,LLC 451 ANDOVER STREET NORTH ANDOVER, MA 01845 Building Inspector Date.... I TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. L ................................... 4 .......... has permission to perform .... ....................... wiring in the building of ............. 4 . . ........................................................ at .... Zj�.I. ......... * 51— North Andover, Mass. Fee .... 3 ............. Lic. No... rRlcL Nst _4 ICAL N��i Check # Nsi6et 10497 Commonwealth of Massachusetts Official Use Only r Department of Fire Services Permit No. 10 1! 1 7 - Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS ,[Rev. 1/071 (leave blank N APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD All work to be performed in accordance with the Massachusetts Electrical Cod(MEC) 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: City or Town of: ]NORTH ANDOVER To theInsp of Wires: By this application the undersigned gives notice of his or 4er intention to per otm electrical work described b;\W� Location (Street& Number) `" 1S� � Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction th a builling per 't? es l?" No EJ (Check Appropriate Box) Purpose of Building 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 end }Mature off Proposed Electrical Work: Tv\� No F � (� C'mmnletinn nfthe fn11nwinaYl7h1e may he waived by the Inspector of Wires. No. of Recessed T,ni»,n^Fres No. of Czil: Susp. (Paddle) Fans No. of Totaldle) Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above E]In- 11o, nd. rad. IN o Emergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Ba�vners FIFE ALS odMS No. of Zones No. of Switches f No. of Gas Burners No..of Detection and Initiating Devices No. of Ranges No. of Air Cones. Total Tons No. of Alerting Devices . No. of Waste Disposers Heat Pump Totals: Number --•• •.•• - ••..•-..•..••••••-•. Tons KW - No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances IOW Security Systems:* - No. of Devices or Equivalent No. of Water KW . Heaters No. of No. of Signs Ballasts . Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: oLUAttach additional detail if -desired, or as required by the Inspector of Wires. Estimated Value of lett 'cal Work:IL_(When required by municipal policy.) Work to Start: ` Inspects to a requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: 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 c��ONVDF`I rce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify:) I certify, under the a' s a d penalties of perjury, that the information on this application is true and complet FIRM NAME• d l aj . �—� LIC. NO.: � Licensee: Cly Wr-\ Signature LIC. NO.: (If applicable, enC"exem " in the lit nse ut bei Zine. V Q Bus. Tel. No.: I Address: o C� Alt: Tel. No.: ` *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" Li ense: 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_ �___ T,,,,,,,,,,,,,,,PERMIT FEE: S The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations T 600 Washington Street Boston MA 02111 www..imss gov/dia . Workers' Compensation Inshrance Affidavit: Builders/Contractors&lectricians/Plumbers Name Address: City 0, �,. - - - 7 2 6LVC� Phone #: Co 1 —7 Are yo nemployer? Check .#he appropriate box: ' h I. I am a employer with 4, ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ I aryl .a.sole proprietor- or have hired the sub -contractors listed I partner- ship and. have no employees on the attached sheet. These subcontractors have working for me.in any capacity, workers' comp. insurance. [No workers' camp, insurance 5. ❑ We are a corporation and its required_] 313 I ain a homeowner doing all work officers have exercised their right of exemption per MOL myself. [Novorkers' comp. c. 1.52, § I (4),'and we have no insurance -required.] t .employees. [No workers' comp. insurance required_] *Any applicant that checks boa'# 1 must also fill out the section Belo h i ' k ' ' 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 13.❑.Other t homeowners who submit this afridavit indicating they am doing all work and {ten hire outside contractors must submia new affidavit indicating such. - #COntTactDrs that check this -box mustettnched an additional sheet showing t_ho name of the. sub-conhactors and their �verka 'temp. polio ;rfo,:, adcm. ! ann rasa employer that Es pr®v1d1ag:wor�fxrsc®FAPevlsad" aasuaapacefoP `,ry enFloyees. Below is the policy randjob site informataom 'n Insurance Company Policy # or Self -ins. Lie. #: Expiration Dat [� _ 1 Z . Job Site Address: t 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 fy der thepains andpenalties ofper'ury that ilae information provided above is true rand correct. Sienature:. — _ _ Date: \ � 1 1' (�_, I 1 Official use only. Do not wr&e Ln suss 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/ own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Oth6r Contact Person: Phone