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Home My WebLink AboutMiscellaneous - 10 OLYMPIC LANE 4/30/2018N O _O O V b O O O O < MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I AWL k MA DATE b� 5^ 6 PERMIT # t Q JOBSITE ADDRESS J& /I P�t OWNER'S NAME P OWNER ADDRESS S AM e. TEL__ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES NO(D FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current fiabifity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ® BOND 0 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 or entered regarding this application are true an rate to the best o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ce e 'nent p ' o Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME JDAVID SILVA LICENSE # 10965 SIGNA RE MP[j- JPD CORPORATION®#PARTNERSHIPFI#LLCQ#D COMPANY NAME I D. A. SILVA PLUMBING & HEATING ADDRESS 1124 SEQUOIA DR. CITY TYNGSBORO STATE F MA ZIP 01879 TEL 978-6491588 FAX 978 2261211 CELL 508-517-622 EMAIL DA.SILVA.PLUMBING.HEATING GMAIL.COM -ia Name Address: The CommonweaI14 ofMassachusejjs . Department of In4ustri4l Accidents Office. of Investigations 600 Washington Street Boston, AfA 02111 www.mas4gov/dia n Insurance Affidavit:Builders/Contractors/Electricians/Plumbers (ala .: rt l{ City/State/Zip:1 ltnttt(��G �Q 1_ p I �_ Phone #: Are you an employer? Check the .appropriate box: 1 • ❑ I am a employer with 4. [� .I tun a generr#1 contractor and I TyPe, of project•(required): eoyeeq (full and/or part -gime).! 2. Mei•am have hired th sub -contractors 6 ❑ New constiuctiori a stile proprietor or partner- Ship and have no employees listed•on the attached sheet. `Ibcse sub -co tractors have i, Remodeling working for mein any capacity. employees and have workers' ' S. ❑Demolition [No workers' comp, insurance .[No comp, insuradce.$ 9, [] Building addition 3• �] i am a homeownerg doing all work 5.0 We are a corporation and its officers have' their 10. 0 Electrical repairs or additions myself, [Nd woYkerg' comp, right of exemption per MGL 11.[] Plumbing repaid or additions 'ofrep: insnranco.fdgt&ed.j t. c. 152•,:W4), and we have no 12•Ej `airs' employees; [No workers 13. [l Other comp. inbura#ce.required.J Any aPPlicarit that checks box #1 mist also BU oui•the section below showing their workers' compenbadon policy inforniadon. t Iiomeownets who submit this affidavit indigatin9 they are doing all wor4'and tht hire outside contractors must submit a new affidavit. indicating such IContmctors. that check this box must attached an additional sheet showing the name of the sub.-contractbrs and stats yrhetha or not those enddq have ensrloyees. It•the sub -contractors have employees,'t}iey must their; provide workers' comp. policynumber. I am an employer that isproviding workers' information. ' compensation Insurance for my employees Below Is thepolicy.and ob site . f Insurance Company Name: . Policy # or Self -ins, Lic. M Expiration Date: Job Site Address: ' Attach a copy of the workers' coCity/State/Zip: . mpensation policy declaratlou page (showing the policy number and expiration date). Failure to secure coveragd 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 -on* impris6nment, 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 ac COPY opy; of this statement may be forwarded to the Office of stieations of the DIA for insurance coveraoe �Prir;�fl~;,,. I do hereby certify under the pains an enaltles of perjury that use area, information provided above Is true and d�^ co�rrecr. 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 S. Plumbing Inspector 6. Other ;n ��, ,,., ,.. ��t; ,,,. .:. , , C.) Thursday, May 19, 2016 03:05 PM Thursday, May 19, 2016 03:05 PM Date .... / ... ............... TOWN OF NORTH ANDOVER -6 PERMIT FOR WIRING C" S T'his certifies that ..... . ......... .... .............. ....... has permission to perform ..... 1KeZ./."../`--& wiring in the buildi , gi� ..... ............... at ......... Iq -/// iL ......... ........ I ....... ........................ . N6fth Andover, Mass. Fee.Y2 �0. Lic. No./ ............. ........ ............................................ Edc�RicAL INsPEcroR Check # e� a Commonwealth of Massachusetts Official U n " Permit No. Department of Fire Ser,Vces Occupancy and Fee Checked BOARD OF FIRE PREVENTION REA�IVY IONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TOJ ERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A LL INF RMATION) Date: _ 1111r21M City or Town of: To the Inspect4 of fres: By this application the undersigned give oti e of his or her intentio t perform the electrical work described below. Location (Street & N ber) Owner or Tenant Telephone No. LIC Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (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 and Nature of Proposed Electrical Work: Installation of Security system Completion o the ollowin table may be waived by the Ins ector o Wires No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- rnd. rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g 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 KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No. o No. o Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors 'dotal HP Telecommunications Wiring: No. of Devices or Equivalent 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 ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrica Work: (When r (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thIDins andpenalties ofperjury, that the information on this application is true and complete: FIRM NAME:ADT Security Secviras LIC. NO.: I regr Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid, see 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 PERMIT FEE: $ Signature Telephone No. f et/0,00, t.r l:liC LUII1111UIlIUC<IItl1 t1t ��il:i!iilCI11I`;Ctta Parn:No. res Y t' �c artuiritt of hiblic �afct w ' P �� 0 Occupancy :. Fee Checked 1 1 BOARD OF FIRE PREVENTION REGULATIONS 527 ChIR 12:00 3190 (leave blink) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code. 527 0!,1R 12:00 (PLEASE PRINT IN INKi R YP ALL INFORMATION) Da:e City or Town of I� To the Inspector of Wires: The udersigned applies for to perform the Eectrical work described belov.,. Location (Street 8 mber) ro,mit 01� ) Sentry Vendor Code Owner or Tenant �cyJ Circuit it,�(/ Owner's Address L�►� Location PhnnA Is this permit in conjunction with zl� building permit Purpose of Building Existing Service Amps -J "oits New Service Amps _� Volts Number of Feeders and Ampacity Yes ❑ No K (Check Appropria:e Box) Utility Authorization Nlo. r^ Overhead II Unagrne ?:o. or %A,aIers Overhead ❑ Undgrnd LJ No. of Meters Location and Nature of Proposed Electrical Work LOW VOLTAGE ALARit SYSTE~ f No. of Lighting OutlotsI No. of Hot Tubs I No. of Transformer Total K VA No. of Lighting Fixtures Swimming Pool Above In- grnd. EJgrnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burnors No. of Emergency Lighting Battery Units No. of SwdCh OUllelr No. of Gar Burnor FIRE ALARMS No. of ..ones No. of Deteellon and Initiating Devices No. of fiangaa No. of Air Cond, Total Iona No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No, of Dishwashors Spaco/Area Heating KW No. of Sell Contained Dotect(on/Sounding Devices No. of Dryers Heating Devices KW LocalC.unicipal Other ❑ Connection No. of Water Heater KW No. of No. of Signs Ballasts Low Voltage Burg e Wiring Card Acess [ CCTV ) No. H%•dro Mesita Tugs No. cl Mnt^rs Total HP No. of Devices V I NLH: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES — NO G I have submitted valid proof of same to the Office. YES O NO O If you have checked YES. please indicate the type of coverage by chocking the appropriate box. INSURANCE r� BOND OTH R` ^(Please Specify) Frontier Insurance Company Estimated Value of Electrical Work 3 / OU Work to Start Inspection Date Requested: Rough Final Signed under the Penalties of perjury: (Expiralion Date) FIRM NAME Security Systems Inc. d/b/a Sentr Protective Sy tems 1109 C Licensee James W. LeesL:C. NO. Signature _IC x100 u tic Bus. Tel. No. (781) 388-9700 Safety) Address 110 Florence St P 0. T3ox 250 iiia en MA. 02148 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its svbstantial equivalent as ro- qulred by Massachusetts General Laws. and Mat my signature on this permit application waives this requirement. Owner Agent (Please check ono) Telephone No. _ , PER -MIT FEE S (Signature of Owner or Agent) x-65,35 Z, -5 -11711k Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ....... 7.�r ................... has permission to perform ........ N ............... wiring in the building of ..... ....... ............................... .... ....... at ... ....... ......................... .. North Andover, Mass:, Fee.... ......... 4�� Lic. No...1.1, 'I ...... ....... ; -t LECIMICAL INSPE'CTOR C 0 �cl'4 � 35. 00 PAID WHITE: Applicant CANARY: Bull(Noeop ,:,,PINK: Treasurer L1 WIN* Date ......... ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING Ni�� /,t ?V&t' This certifies that ... Pj �� i ................ T-:? ............. Y has permission to perform Dx m . ....... wiring in the building of ....... ... ........ . ... .............. .. ..... North Andover, Mass. wCheck # ELECTRICAL INSPECTOR 5 7 col 11 JIM LUIMVIUIVVVVAII !n Ur Irirs,axia,nULNUAiu �•••� ,/ DEPAJUME TOMBUCSOM Permit No. BOARDOFFMPREMMONRDGUTA77O M5VaR1ZiW Occupancy & Fees Checked APPLICATTONFOR PERMIT TOP ORM ELECTRICAL Milzv ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE CHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat V Town of North Andover To the spector of Wires: The undersigned applies for a permit to perforin the Location (Street & Number) %( Owner or Tenant Owner's Address Is this permit in conjunction with a Purpose of Building permit: Yes [:3 No E3' (Check Appropriate Box) Utility Authorization No. Existing Service Amps Volts Overhead a Underground ED No. of Meters New Service Amps Volts Overhead E3 Underground 1= No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work U rL4 QA No. of Lighting Outlets No. of Hot Tubs/%' No. of Transformers Total _J, KVA No. of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of On Burners FIRE ALARMS No. of Zones No. of Ranges No. of Au Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwasher Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heater KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motor Total HP a OTHER t Ihareaa�tLiehiTttyi�ttcaeFb6cyirrltldtt$Car>p� ar�rialt�gLtivalat YES NO Iharesub niaBdvaidptoofofomlO he011l Z YES XyqubRW �pkeidC*l leWcf by the l'" / 406e ,31 F.xpitadortDete EftVadVArdElMkmdWdk $ WadcbStaR htsp MmDoteRe4teWd Rottgh Find Stgnedurtder ofpt3ji=y �� FIRMNAME Liaat9eNa ri� T • OWNER'SP6t ANCEWAM3k-IamawaTetha dzldmwdoesmthm ardd>a<tmyagnatuemthtspamtapp6c�alwal�esdzciaqu�r�t (Please check one) Owner Agent M t Signature n IxaneNO BusineTsTdNo. r=>v AItTdNo. mWv'alentasW4medbyNb=diiMGerlaWL %s Telephone No. PERMIT FEE S