HomeMy WebLinkAboutElectrical, Plumbing and Gas Permits - Permits - 50 COMPASS POINT ROAD 3/1/2015 f
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Common wealth of Massachusethq
Permit 1 o.
ti a Fire Services
Occupancy and Fee Checked
w AR FIREPREVENTION R E G U LATI 1 S
5rev, jjo7jle ve b,ank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 CMR12.00
(PLEASE PPJNT ININK OR TYPE ALL MF01 U M N Date:
City or Town : NORTH"H ANC]oV R .,� To the Inspector of Wires.
-
BY Us application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location Street&Number
'� f x I.--�
[owner or Tenant ` Telephone
,30
Owner"s Address 00 M. Llx 4 t
Is this permit in coni unction with a building permit. Yes No (Check Appropriate Box)
Purpose ofBuilding ¢� {�� : � � f Utility Authorization No.
Existing Service Amps It overhead ndgrt No.of Meters
New Irv*Lee
Amps iY1 , Volts Overhead D Undgrd No.of Meter }
Number of Feeders and Ampacity
Location and Mature of Proposed Electrical Work:
ar p etion ofthe following table may be walved by the inspector of Wires.
o.of Recessed Luminaires Igo,of Ccil.-Sty addle Fans No.of dotal
Transformers KVA
o.of Luminaire Outlets No.of Hot Tubs Generators K . .
Above In- o. mergency ig ting
No.of.Luminaires wimming Pool rnd. Ei �
arnd. atc�r nits
No. of Receptacle outlets No.of oil Burners FME A-LRM T . ( Zone
No. of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No. of Ranges , No.of Air Cond., I Total � No.of. lertingDevices
Tons
y Heat Pump Number Tons KW No.of Self-,Contained
'totals ...............................................
,No.of Waste Disposers
Detection/Alerting Deice
No.of Dishwashers �{ 18pace/Area Heating K' Local.El Municipal � Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
T .of Devices or Equivalent
o. of Water ��' No.of No.of data Wiring:Heaters - B to is No,of Devices or Equivalent
No. drone a Bathtubs No.of Motors Total Telecommunications Wring;
g o.of Devices or Equivalent
OTHER:
Z� Attach additional detail if desired, or s required y the Inspector o, Jnres.
stimated Value of lectric l Fork: q � ,�- ov men required by municipal policy.
'work to Start: Inspections to be requested iu accordance with NEC Rule 10,and upon.completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrloal 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 perit issuing office.
BE K ONE: INS BOND THE (Specify)
cer?fy, tinder the p ains andpenalties ,fp erjury,th at th e in rn�c�to o this application i true and om
Licensee: , b Signature I .NO.:
( iexca ` err ' thcererr� -
. r5 ¢,
Address- M M. Pp� AA ilte c.�o.: �° -I
" �
per M.G.M.G.L c. 147, S. 57-6 1,security work requires Department of Nbric Safe "8"tfc6 se: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norm
required by law. By my si gnatare below,I hereby waive this requirement. I am the(check one)EI over El omner"s agent.
Owner/Agent
Signature Telephone No. PE .SEE:
El 0 a ac1husetta leetri61Code-A nd' eint'' CMR 1 ( U1 .' ar a rclarl a ill the-provision6f M.G.L.c. 143, 3L,the :.:. :...:.:.::..
permit application'form 16%proved notice of install tiori of iri'n 's'h91 b ."unii or throughout the Commonwealth,and applications shall be filed
on the prescribed fornx.After a permit application has been accepted by an Inspector of Fires appointed pursuant to M. GI c. 166, §32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application, Such entity shall be responsible for the Y
notification of completion of the work as required in M.CTL e.143,§3L.
Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not corn enced or has not progressed during the preceding 1 -month period.Upon written
application,an extension of time for completion of work shall be permitted for reasonable cause,A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
The Permit Extension Act was created by S eotion-,1.7 .of Chapter 24.0_ f the_Acts of 2 01.0 and extended by Sections 74 and 75 of Chapter 2 3 8 of
the Acts of 2012..The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension.Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With
limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was
"in effect or existence"during the qualifying period beginning on August 15,2008 and extend ing'thro gh August 15, 012..
11 Kyle 8—Permit/Date Closed: _......._� Note: Reapply for new permit 0
D Permit Extension Act—Permit/Date Closed:
Trench IpMection
Pass ? Failed e-Inspection Required{ .
Inspectors Comments:
Inspectors Signature; Date:
SERVICE INSPECTION:
Pass Q Failed Re-Inspection Required{ El
Inspectors Comments:
Inspectors Signature: Date:
PARTIAL ROUGH ASP CTION:
Pass Failed -Inspection Required El
Inspectors Comments:
Inspectors Signature: Ito:
ROUGH CTI N:
Pass ? V Fared Pe-Inspection Required . El
Inspectors Comments:
OF
Inspectors Signature: Date: _ 6419---Is
IFIMNAL INS C 'I N:
Pass M Fin -Inspection Required El
InspectorsComments:
Inspectors Signature., �. � Date: 19
DEB l EINH L ...TOWN OF MERRII MA ,MA. .......dwe nhold a@to nofinerrim .com
O
The Commonwealth Massachusetts
Department o;f.fin dns ccide is
Congress Street, Suite 100
Boston, MA 02114-2017
,- www.mass.go v1dia
Workers'Compensation Insurance.Affidavit;Builders/Contractors/Electricians/Plumbers.
TO BE FILED W TkI THE PERWTTING AUTHORITY.
App
licant Information Please Print b�
Ncl"1r1rrntxr}cxxda
A Orb
Air .
City/State/Zip: r Phony .
Are you an employer?Cheek the appropriate boas: Type of project(required):
r,T
1. I am a employer with employees(full and/or part-time).* 7. Now construction
. 1 an a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.
� El Demolitio
1E]I a in a homeowner doing all pork myself[No workers comp.insurance required.
1 [:]Building addition
4. 1 ain a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
.F-1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers comp.insurance.
. We are a corporation and its officers have exercised their right of oxemption per M L c. 14.E]Other
, 1. ,and we have no employees.[No workers'comp.insurance required,]
Any applicant that cheeks boar#1 must also fill out the section below showing their workers'compensation policy inf"or ation,.
t Homeowners who submit this affidavit indicating they are doing al[work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of thesub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers"comp.policy number.
am an employer that is providingworkers'compensation insurancefor ray employees. Below is thepolicy a dj b site
information.
Insurance Company Name:
g' x
I ly y I
Y
{? l � � r ............... Expiration Date:
Job Site Address: #I F o- i)N L�e City/State/Zip:
Attach a copy of the workers'compensation policy decl4ration page(showing the policy inumber and expiration date).
Failure to secure coverage as required under MGL c. 12,§25A is a criminal violation punishable by a fine►gyp to$1,500.00
and/or one-year imprisonment,as well.as civil penalties in the form of a STOP WORK ORDER and a fire of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office ofInvestigations of the DIA for insurance
coverage verification.
do hereby certify under the pains andpenalties ofperjuty that th in ormation providedb is true at;d correct.
Signature: V_ Date:
Phon : �
1ci t use only. Do not write in this area,to be completed b, city or town official
City or Town: Permit/License#
Issuing;Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clergy. 4.Electrical Inspector 5.Plumbing Inspector
.Other
Contact Person: Phone#:
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has pIerrnl.SSjOn � � .•,
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PLUMBING INSP16,CTOF,
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY NORTH ANDOVER owhw... A, DATE1.5-27-15.. .
PERMIT
CBSITE ADDRESS 1.5.0 COMPASS POINT OWNER'S NAIVE TRUST CONSTRUCTION
OWNER ADDRESS: 51 MT JOY DR TE III SBURY MA 0.187.6TEL: 978 8513456FAX:
TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL
PRINT
CLEARLY NEW- RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES EI NOE]
FI UTI ES I FLOORS Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 2
CROSS CNN DEVICE
DEDICATED SPECIAL WASTE SYS
DEDICATED GAS101USAI D SYS
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYS
DEDICATED DATER REUSE SYS
DISHWASHER
DRINKING FOUNTAIN
-FOOD WASTE GRINDER UNIT
FLOOR/AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY
ROOF D RAI N
SHOWER STALL
-SERVICE/MOP SIN
TOILET 1
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER ALL TYPES I
-WATER PIPING 1
SPIGOTS
INSURANCE COVERAGE
I have a current Ilabill insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q N ❑
If you have checked YES,please indicate the type of coverage by checking the appropriate box below;
LIABILITY INSURANCE POLICY OTHERT PE INDEMNITY F BOND ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted for entered regarding this applicatic r and ur the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this applic cn be i e with all Pertinent
provision of the Massachusetts State Plumbing Cede and Chapter 142 of the General Laws.
PLUMBER NAME: MIKE BURI E ILICENSE#113127 V IGNATURE
COMPANY NAME: POWERHOUSE PLUMBING AND HEATING GORP . ADDRESS: P0.130;(W .. ................
CITY;[PLAISTOW STATE: Ny ZIP; 1..03865 FAX: 60-33780040
TEL: 16033780020 ........ CELL: 19784909385 .,........_ EMAIL J.LAU OWERHOUSEPLUMBING-COM
MASTER JOURNEYMAN❑ CORPORATION ..2482 P RTI ERSHIP❑# LLc El#
ROUGH PLUMBINGINSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTJON NOTES
Yes No
THIS APPLICATION BERMES AS THE PERMIT
FEE; PERMIT
PLAN E I W NOTES
MAS AC USETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
.. . ......... CITYI...NORTH AND OVER ILIA. DATE -27-15 PERMIT#
J BSITE ADDRESS o COMPASS POINT OWNER'S NAIVE TRUST CONSTRUCTION
OWNER ADDRESS. 51 NET JOY DRIVE TEWKSBURY MA TEL: 1.9.7834 FAQ,
TYPE O�t
OCCUPANCY TYPE: C MMEI CIAL❑ EDUCATIONAL El RESIDENTIAL�
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:ENT:F PLANS SUBMITTED:: YES❑ N ❑
FIXUTI ES J FL R -+ Bsmt 1 2 S 4 5 6 7 8 9 10 11 12 13 1
BOILER
BOOSTED
CONVERSION BURNER
COOT{STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FIYLATI
FURNACE
GENERATOR
GRILLE
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATED
ROOM I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UN VENTED TED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
I have a current IIabIII insurance policy or its substantial equivalent which meets the requirements of III L.Ch.142 YES N ❑
If you have checked YES,please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY 9 OTHER TYPE INDE NITY ❑ BONDE]
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application naives this requirement.
CHECK ONE ONLY: OWNE AGENT El
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this application are /4nd
rat the best f my
Knowledge and that all plumbing work and installations performed under the permit issued for thisa�pplicatio IIIi a with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUI IBEIIOASFITTEf NAME:E: DIKE BUR E LICENSE#113127 S AT
COMPANY NAME: POWERHOUSE PLUMBING AND HEATING COMP ADDRESS:lpo.�.Q�....... 3 ......
CITY: PL IST W._..._........................ STATE: I NH..I ZIP; 1.2y65... . .... ............ FAX: 33 ....
TEL: 37' 00o CELL: 73 EMAIL: .. fl a�P1lEPLI � f ... `Y'I .
MASTER JOURNEYMAN ❑ LP INSTALLER CORPORATION ATI I N#12482 PARTNERSHIP❑ ... ........ LLC❑
ROUGE GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSP ''Y N NOTES
r
1
Yes No �
THIS APPLICATION SERVES AS THE PERMIT ❑
PEE: PERMIT
PLAN REVIEW NOTES
The Commonwealth of Massachusetts
Department ofIndustrialAccidents
rpt
w Office ofInvestigations
Congress Street) Suite 100
Boston, MA 02 -2 7
www.mass. o1dia
Workers Compens fi n Insurance cc A a
i s Builders C r� �' r E l ri i s l r
Please
Avy
lican Information ---
Print Ise i
POWERHOUSE PLUMBING CORP
Nand. Business/organization/Individual .
Address: PO BOX
896
• • • PLAISTOW, H 03 Phone 6033780020
� ty �tac �1p.
Are you an employer? Cheek the appropriate box* Type of project(required):
r with I a general contractor and I
1. ■� � �n a employe New construction
employees and/or art-tune .* have hired the sub-contractorsll� ❑ Remodeling
2.0 ha sole proprietor or partner- listed on the attached
heed
ship and have no employees These sub-contractors have 8. Demolition
r me in capacity. employees and have workers' Building9. E] addition
worn o y
' comp. insurance
comp. insurance.*
[No workers' eo 10.� Electrical repairs or additions
5. EJ w are corporation and its
require
d.�
officers have exercised their 11. liurnoin repairs or additions
3.0 f am a homeowner doing all work
o workers' right of exemption per MG 12.[] Roof repairs
myself. � corn� ce 152, §f(4),and e have no
insurance ref ired. 1 , Other
employees; [No rorlers'
comp. insurance required,]
"r
1lcant that checks box#1 must also fi ll out the seetlon below showing their workers'compensation pulley in#`orr�atlon.
n
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Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors must submit a new affidavit indicating such.
Contractors that check this b ox 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 roust provide their workers'comp.policy number.
n employer that I' r� #din workers'compensation in r�a nee far any employees. Below i the lie site
f
am ap
information,
#: HARTFORD UNDERWRITERS INSURANCE COMP
k: Insurance Company Marne:
-28-15
r: Policy##or Self-ins. Lie. #: I ECIT2 piration Date:
r: 5 compasspoint City/State/Zip: N Ar1C�C 11 �" 1
845
Job Site Address:
Attach copy o
theory ' compensation liey declaration page{showing the policy number and
of
>: ion 25A.of MOL c. 15 can lead to the imposition of criminal penalties of
r:
Failure to secure coverage as redo under feet
r door one- imprisonment, as well as civil penalties in the form of STOPWORK ORDER and a in
>. rye up to l,5OU
of up t $ 5 .0o a
against a iolator. Be advised that cols o this statement n ay lac�'orwa�- ed to the free o
Investigationso for n anee coverage verlf'icatxon.
• nos erjurythat the information provided ae is true and correct*
do Hereby c fif rider r pa n and p
5-27-15
Date:
Signature:
Phone . /6300020
.
Officialnod rite in h- area, be completed ,�d by city or town ciaL
use only.
' or Town: Permit/License
City
Issuing Authority(circle one):
' . i /Town Clerk .Electrical Inspector .Plumbing Inspector
1.Board of Health .Building
. Other
hoane#:
Contact
Person:
ff:
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