HomeMy WebLinkAboutMiscellaneous - 35 Redgate Lanew
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A**/'**ZrEL EN(51NEFORIN
S T R U C T U R A L C O N S U L T A N T S
November 12, 2007
Mr. Gerald Brown
Inspector of Buildings
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
RE: FRAMING INSPECTION
35 RED GATE LANE
NORTH ANDOVER, MASSACHUSETTS
Dear Mr. Brown:
A representative from Martel Engineering visited the site on Monday, November 12`", 2007 to
inspect the framing construction and its construction in accordance with the plans. The framing
located at the residence at 35 Red Gate Lane was acceptable to the engineer and constructed in
accordance with the plans and field recommendations. The manufactured timber used in the
construction was per plan, and is acceptable to this office.
Should you have any questions, please feel free to contact our office.
Sincerely yours,
MARTEL ENGINEERIN •A 4,4
OF•
MICHAEL E. L
q MARTEL
STRUCTURAL
No. 41874
Michael E. Martel P.E.
r T����
Principal Engineer �aNALEN _.a
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 155 (8/28/07) Date: September 8, 2009
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 35 Redgate Lane
MAY BE OCCUPIED AS Single Family Dwelling IN
ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING
CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.
Certificate Issued to: Chestnut Way Construction
12 Chestnut Way
^, ethuen MA
Building Inspector
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Date... 16. .�.. �...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..................4. .e % .�Lk..r-77;x? K r
has permission to perform ........... . ......t'in.Q..�.F. ..........................
wiring in the building of .s 7`- r.T' WAS 1.......(..U?
at .....37- ...... &D.��.......................... . North Andover, Mass.
FeeLic. No../5,2-' Z�
ELECTRICALINSPECTQ
Check #
7763
-U -N Commonwealth of Massachusetts Official Use Only
9MW Department of Fire Services Permit No.
flaw
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 (MEC), 527 CMR 12.00
(PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: (6 .- 3
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of 's or her irate on to perform the electrical work described below.
Location (Street & Number) �,�
Owner or Tenant Telephone No.
Owner's Address( Y%
Is this permit in conjunction with a building per 't? Yes [ No ❑ (Check Ap ropriate Box)
Purpose of Building�i�W r. -,Q Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service '2Cj0 Amps 10 /?,2UVolts Overhead ❑ Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No, of Recessed Luminaires
No. of Luminaire Outlets
of Luminaires 1;) C -D
No. of Receptacle Outlets 5 d
No. of Switches 50
No. of Ranges
No. of Waste Disposers
„ No. of Dishwashers
No. of Dryers
1 o. of Water KW
Heaters
No. Hydromassage Bathtubs
Completion of the followin
No. of Ceil.-Susp. (Paddle) Fans
No. of Hot Tubs %
Swimming Pool Above ❑ In- ❑
:trnd. grad
rne
No. of Oil Burs
No. of Gas Burners
No. of Air Cond. °
{/ Tons
Totals:
Space/Area Heating KW
Heating Appliances KW
No. of No. of
Signs Ballasts
No. of Motors Total HP
ttable ma be waived b the Inspector o Wires.
, ofTotal
ansformers KVAnerators KVA
Units _
ALARMS INo. of Zones
o. of Alerting Devices
o. of Se -Contained
Municipal El '� Connection ❑ Other
urity Systems: *
No. of Devices or Equivalent
:a Wiring:
No. of Devices nr F.nnivalpof
of Devices or
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: t% _ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVE 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE M, BOND ❑ OTHER ❑ (Specify:)
I certify, under the ains a d penalties perj , that the i formation on this application is true and complete.
FIRM NAME: e,, LIC. NO.:
Licensee: Signature LIC. NO.:
(If applicable, a ter " mpt" in t e cense number h e.
Address: h y s. Tel. No.3
-
tt.
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Y L cl. 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. $
137
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11
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
C-1 www.nzass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #: .
Are you an employer? Check the appropriate box:
L ❑ I am a employer with 4. ❑ I am a general contractor and I
e sec ion ow sh
Type of project (required):
employees (full and/or part-time).*
2. [] I am.a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. =
6. New construction
7. ❑ Remodeling
ship and have no employees
These subcontractors have
8. Q Demolition
working for me .in any capacity.
[No workers' comp, insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
g, ❑ Building addition
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
right of exemption per MOL
10•❑ Electrical repairs or additions
1 1.[ Plumbing repairs or additions
myself. [No -workers' comp.
c. 1.52, § 1(4),'and we have no
12.[] Roof repairs
insurance required.] t
employees. [No workers'
1.3.0 Other
comp, insurance required.]
*Any applicant that checks ho)C # I must also fill out th f bel '
owing theirworkers compensation policy information.
t Homeowners who submit this affidaVit indicating they are doing all work and then hire outside eontractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-conmwtors and their workers' comp, policy information.
I am an employer that is. providMrWorkers' compensation insurancefor my emptoyeeL Below is the pOlicy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lie. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration datie�
Failure to secure coverage asrequired tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine tip 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 eorrecG
Signature: Date:
Phone #:
OffZcial 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):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone 4:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual,, partnership, association, corporation or other legal entity, or any two or more
of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. 'However the
owner•of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence.of compliance with the insurance 'coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented .to the contracting authority."
Applicants %
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es).and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or, Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carr workers' compensation insurance. if an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit -may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage.. Aiso 'be sure to sign and date the affidavit. The affidavit should
be returned to the city, or town that the application for the permit or license is being requested, not'the Department of
Industrial Accidents. Should you have any ;questions regarding the law.or if you are required to obtain a workers'
compensation policy, please call the Department at the numberlisted below. Self. -insured companies should enter their
self-insurance license number on the appropriate dine.
City or Town Officials
Please be sure that the affidavit is complete and printed -legibly. The Department has provided'a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permitllicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of -the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7748
www.mass.gov/dia
Date ..`�/. l ... ?. .
i
�'<: •:'� TOWN OF NORTH ANDOVER
' PERMIT FOR PLUMBING
This certifies that ...i1 �--�.. 7. t . h. (A 1.7-�,.. �..... .........
has permission to perform .. !i .l . t.e.-.. ........
plumbing in the buildings of . , r. I ...�— .."-c'.: � .. .
at ... 3. ?` .. /?-r.. � I.P. <...�' �......... , North Andover, Mass.
�.
Fee. �.. �" ... Lic. No..% ..�' ... ....t:a-... N....r,..
PLUMBING INSPEC OR
Check # << r
7 4 9 ;:
1\
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,R,,M_ jASSACHUSETTS —7
ICU-/ z-� Own. Name ch�S nu� Co�j s+�uAPerDat
Building Location .Permit # i Y r.;—
Amount—
Type of Occupancy
New Renovation Replacement 0 Plans Submitted Yes No C]
FIXTURES
(Print or type) C� I?�Check one: Certificate
Installing Company Name orp.
Address P 0, E S ] Partner.'
Business Telephone 62, — �7 7e-0 O'Z Firm/Co.
Name of Licensed Plumber. ��5%%�SLiG'21ifGGd
Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box
Liability insurance policy 0 Other type of indemnity Bond
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
best of my knowledge and that all plumbing work and
compliance with all pertinent provisions of the M5a, By: Title_�
City/Town r
APPROVED (OFFICE USE ONLY
�ed (or entered) in a application are true and accurate to the
T7 un Issu�edthis application will be in
tomb' hapteeral Laws.
Ocn
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Master M Joumeyman ❑
Date...- Z.'—<.-?.....
o�Z.'� %
TOWN OF NORTH ANDOVER
'PERMIT FOR GAS INSTAL
U` _ ° y♦
, �1c � ."�tS
This certifies that ... �. .. !� ..c. �. ? ...................... .
has permission for gas installation .. ' .�.. . J A
in the buildings of ... �.c ,..�. ........... .
at .............. North Andover, Mass.
Fee. ? 9. ^ Lic. No.ti''' ..... . .... .....
GAS INSPECTOR
Check #
6131
IN
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date /-/5
NORTH ANDOVER, MASSACHUSETTS -07
Building Locations 3 S �e,D 6�e z—ew—
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Owner's Name
Replacement D
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Amount $
New Renovation
Plans Submitted
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B A S E M ENT
1ST. FLOOR
2ND. FLOGR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
H. FLOOR
7TH. FLOOR
8TH. FLOOR
(Print or type)
Name of Licensed Plumber or Gas Fitter
Certificate Installing Company
Partner.
Firm/Co.
INSURANCE COVERAGE Check one:
I have a current liability Insurance, policy or it's substantial equivalent. YesNoO
If you have checked }_es, please i icate the type coverage by checking the appropriate box.
13
Liability insurance policy Other type of indemnity Bond 13
Owner's Insurance Waive : 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.
Signature of Owner or Owner's Agent Check one:Owner rl Agent
I hereby certify that all of the details and information I ha itted (or entered) in abo a application are true and accurate to the
best of my knowledge and that all plumbing work an stallation performed under P it Issued for this application will be in
compliance with all pertinent provisions of t ac Sta Gas Code an apter 142 of the General Laws.
!By: nature of Li sed Plumber Or Gas Fitter
Title Pi Umber
City/Town Gas Fitter (censeum er
Rff2Y Master
APPROVED (OFFICE USE ONLY) Journeyman