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HomeMy WebLinkAboutMiscellaneous - 102 SPRING HILL ROAD 4/30/20180 0 OD o v 1!JJC. Date .....V//A57.... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .......�\....P^ ^" �... . ................................... has permissiofl3o perform ... �. R:- /� .....Ax.1.... ..... '.. plumbing in the buildings of........fr.....✓.h............... ...................... at .............. .Q'Z... ! ..!r.03Y !!/ .......................... North Andover, Mass. Fee..��.......'-.... Lic. No. ................................................................................. PLUMBING INSPECTOR Check # ©°Z` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY NORTH ANDOVER ____ ._ MA DATE 9-2-2015 PERMIT # 11 JOBSITE ADDRESS 1102 SPR9ING HILL ROAD OWNER'S NAME NICK RETHMAN POWNER ADDRESS SAME TELI 978-836-0884 - FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL [:1 RESIDENTIAL E] PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES[] NOD FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM - DISHWASHER DRINKING FOUNTAIN r FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING __ _ -- ---- OTHER JIL 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ej NO [3 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE OF INDEMNITY 0 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 Q 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 and accurate to the st of my kn wledge and that all plumbing work and installations performed under the permit issued for this application will be in co Iia a with all P i t pr isio the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I. KENNETH J ROBERTS LICENSE # 11934 IGNATURE MPQ JP® CORPORATION# 3304 PARTNERSHIPQ# LLC®# COMPANY NAME I ABSOLUTE PRECISION ADDRESS P.O. BOX 1260 CITY MIDDLETON STATE MA ZIP 01949 TEL 978-774-8835 FAX 978-777-5371 1 CELL EMAIL I KEN@ABSOLUTEPRECISIONPLUMBING.COM This certifies that .. Date.................../... ............ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION op,/ ............ . , ....................... ...... . .................................. has permission for gas installati k.*..�Al ........................................... in the buildings of ......... zd"..... at ..... /0 .. ...... .......... I .......................... ................ North Andover, Mass. Fee..*.—... Lic. No..//,1-3./ ... ..................................................................... GAS INSPECTOR Check # 161 I v \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — b CITY I NORTH ANDOVER MA DATE9 2 2015 PERMIT # I nI W 2- JOBSITE ADDRESS102 SPRING HILL ROAD OWNER'S NAME FICK RETHMAN G, OWNER ADDRESS I SAME 78-86-0884 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:O RENOVATION: 0 REPLACEMENT: PLANS SUBMITTED: YES® NDE] APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ - -- ROOM / SPACE HEATER ROOF TOP UNIT - TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ _ - -- - --- OTHE INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY ® 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 Ej 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 and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance provisi of the Awithine Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME I KENNETH J ROBERTS j LICENSE #=— SIGNATURE MP El MGF 0 JP E] JGF E] LPGI 0 CORPORATION Q# 3304 PARTNERSHIP[]# LLC ®# COMPANY NAME: ABSOLUTE PRECISION ADDRESS I P.O. BOX 1260 CITY I MIDDLETON STATE F MA -1 ZIP 01949 TEL 978-774-8835_ FAX 978-777-5371 ]CELLI EMAIL KEN@ABSOLUTEPRECISIONPLUMBING.COM 1 v \ J r , The Commonwealth of Massachusetts Lh Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: A6W/o t -e PflEe"re,-t pluT)7 ` tf EITTn& r e pet rhG _V41 � Address: P• d Ro r City/State/Zip: m Lo of cro - i M69 0 /5'f'S Phone #: X17 b 7 i- jf-j- 3,5 Are you an employer? Check the appropriate box: 1 I am a employer with employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]* 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. (No workers' comp. insurance reg.) Business Type (required): 5. ❑ Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10.❑ Manufacturing 11.0 Health Care 12,TOther e0'1 S70U (7--W " 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. "If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #1. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: 2 u RT C 14 — R n7 -EA J-69 oi -rh j u ea ,7 7C Insurer's Address: 6-'eo'1 e3j T SG! U eTo 7 f / 8w,1igL fi , woo -Jr p r' rc/t- f t a'G3 % ,Qv R �rry c r-�, �, Q ba -- SS � City/State/Zip: � / Policy # or -Self -ins. Lie. # we �Y� 9 % S -0 Expiration Date: 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 andJjenylties ojp,Vjury t/ pt the information provided above is true and correct _7k--27 Official 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. Licensing Board S. Selectmen's Office 6. Other Contact Person: www.niass.gov/dia Phonc #: v COMMONWEALTH OF MASSACHUSETTS !] 101:11:1:512 M-1 I0 PLUMBERSBOAV VASFITTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A JOURNEYMAN PLUMBER KENNET{ J ROBERTS W PO BOX 1260 MIDDLETON MA 01949-3260 22552 05/01/16 223979 ti v COMMONWEALTHOFMASSACHUSETTS PLUMBE4tS W 5SF1TTERS ISSUES THE FOLLOWING LICENSE LICENSED AS A MASTER PLUMBER �y us KENNETH J ROBERTS`�, Z P.O. BOX 1260 � U MIDDLETON MA o1g4g-3260 .,yJ 11934 05/01/16 223978 v COMMONWEALTH OF MASSACHUSETTS bilri mm gilol 3:1 -• • BOARS? OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE REGISTERED AS A PLUMBING CORP .Q z KENNETH J ROBERT N ABSOLUTE PRECISION PLB. S HEATIN 5 WILDWOOD RD W u MIDDLETON MA 01949-2133 3304 05/01/16 204671 s N°' Z J CJ Date.. 0 26-.719 1 f pOR7Fl 3:;•';�`":''."�O� TOWN OF NORTH ANDOVER # PERMIT FOR WIRING ;,SSACHUS� i This certifies that :... `�.� ......................_... ...............................g has permission to perform_,. ........................... wiring in the building of '' J................................ . .......................N at ......... ....................... :North Andover, Mass Fee.... `.�........ Lic. No....... ` /• ELECTRICAL INSPECTOR &'5 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer q officf U \ The Commonwealth of Massachusetts Occvo+ney k k, Check.d Department Of Public Safety 3/90 (leave btanki BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK ORTYPE ALL IN.7RHdTIQr� City or Town of Or� /rh�t id �V The undersigned applies for a permit to perform � the electrica Location (Street S Number) / D 9 �//('1Y4_A Owner or Tenant Date To the Inspector of Wires: REG CPY 1 work described below, RCT ACT a P14. Owner's Address Is this permit in con jjCcttion with /a building permit: Yes ❑ No (Check Appropriate Box) po Purse of Building 5 icle/ /16 a / Utility Authorization NO._ Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No of Meters New Serv-ice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity, Y Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transforrers Total KVA No. of Lighting Fixtures SwimmingPool Above In- oogrnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners Ba of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of .sir Cond. tons Initiating Devices No. of Sounding Devices No.,of Self Contained Detection/Sounding Devices _ Local ❑ Municipal ❑Other Connection No. of Disposals P No. of Heat Total Total PumDS Tans KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. o Signs Ballasts Low Voltage Wiring No. Hydro Massage Tubs No, of Motors Total HP ?d OTHER: 1 X 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 C] NO C] I have submitted valid proof of same to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE I/II BOND ❑ OM ER F-1(PleaseSpecify) ' TQ Expiration Date Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final GE 1 Signed under tVRA >e Oo Lpg"jury? _— 7 FIRST NAME__ 155 WEST sT-RPr "'� -.,-_ - _LIC, N'�. WILMINGTON, r;��!: Licensee Signature IC. NO. • �!" Bus. Tel. No. Address nv G 1,365 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent BC -44A MASSACHUSETTS UNIFORM APPLICATION FOR P RMIT TO DO PLUMBING (Print or Type) / g16 v c,/' Mass. Date 2 au 19 �� Permit 3 Building Location _ / 6 a S� �� n � Owner's Name velli A- Type of Occupancy / r New ❑ Renovation Cl Replacement Plans Submitted; Yes ❑ No O ru B.P.# SEWER# FIXTURES SEPTiC r't t r if Stalling Company Name • The Plumbing Co., Inc. :Addreu P O Box 1607 Wakefield Ma 01880 Business Telephone 781-246-0019 Check one: 13 Corporation ❑ Partnership ❑ hrm/Co. Certificate # 1219C i of Licensed Plumber _ Clifford H. Giles `1SURANCE COVERAGE: a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes LSC No ❑ have checked Yn. please Indicate the type coverage by checking the appropriate box liability Insurance policy �( Other type of Indemnity ❑ Bond ❑ 'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: )f Owner or Owner's Aaent Owner ❑ Agent ❑ certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of my 0 and that all plumbing work and installations performed under the permit issued for this application will be in comptianoe with all i protisions of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. gnatur Licensed umber Type of License: Master ❑iC Journeyman ❑ PPHDVED (OFFICE USE ONLY) J License Number 8701 _ Z N = y N J Z Id < N us H be Z N 4 ac Q U F- Z � 0 N a Qj � • O N W N o = N F U W H Y _ < N W •� O Z a •d W y-1 x . V a Z W O O Q W N ¢ 19 Z i W _ CL v< x W 3 s x= 3 N a rr O M _1 k r a. +J U N < > < r- < O T N N _ O N F- Zr O O y Z ?. W 0 O X u O 4! of K. c� o < >G RC O q 0 SUR—BSMT. BASEMENT I 1ST FLOOR 2NOFLOOR 2R0 FLOOR 4TH FLOOR STH FLOOR eTH FLOOR 7TH FLOOR STH FLOOR . -1 11 H Business Telephone 781-246-0019 Check one: 13 Corporation ❑ Partnership ❑ hrm/Co. Certificate # 1219C i of Licensed Plumber _ Clifford H. Giles `1SURANCE COVERAGE: a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes LSC No ❑ have checked Yn. please Indicate the type coverage by checking the appropriate box liability Insurance policy �( Other type of Indemnity ❑ Bond ❑ 'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: )f Owner or Owner's Aaent Owner ❑ Agent ❑ certify that all of the details and information i have submitted (or entered) in above application are true and accurate to the best of my 0 and that all plumbing work and installations performed under the permit issued for this application will be in comptianoe with all i protisions of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. gnatur Licensed umber Type of License: Master ❑iC Journeyman ❑ PPHDVED (OFFICE USE ONLY) J License Number 8701 _ .J z 0 w N w v w 0. O Q O 0. d J w W LA z O_ u W a z w a LW a c� O a a� O W z U LLI W W W 0 z m 0. O Q O N z � U O w _ � � J O U. 0. O z w LL a O _O H ~ a O a �( z J d O w z Q ILI H z w CL r Date...3/`�. . .- 3622_ A TOWN OF NORTH ANDOVER a PERMIT FOR PLUMBING S u; This certifies that .. /.�L.b l�' �j . �4.,../!z �................ has permission to perform ... ........................ o co plumbing in the buildings of .. ,.{�!k ................ a' N CU at. ........ . , North Andover, Mass. o Fee. ."... Lic. No.. c.l 7 v l ... P�IMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ��� ✓ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTINQ l (Print or Type) n 6 !l � , Mass. Date 2 - ao 19 Per/mit # %� Building Location /aa. ✓C��, , y /�,�� /t��• Owner's Name t'7 ��"�� �/� ° � Type of Occupancy 2L V Now ❑ Renovation ❑ Replacement E Plans Submitted: Yesp No ❑ InstaNlnp Company Name The PI u m b i n g Co., Inc . Check one: Certificate # Address P O Box 1607 Corporation 1219C wnkefield Mo 01880 ❑ Partnership Buslness Telephone 617-246-0019 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Clifford H. Giles INSURANCE COVERAGE: I have eyes ent liability ns 0 ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 9 you have checked yes. please Indicate the type coverage by checking the appropriate box. A IW Aity Insurance policy CK Other type of Indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: 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. Check one: nature of Owner or Owner's Agent , Owner❑ Agent O hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in complienoe with atl PwUnw t Provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws ey �— T e of License: Plumber Signature cen um r diet � Gasfiiter Master License Number 8701 APPF ED t Journeyman EM5 ��������������� V1/11111■ Ell InstaNlnp Company Name The PI u m b i n g Co., Inc . Check one: Certificate # Address P O Box 1607 Corporation 1219C wnkefield Mo 01880 ❑ Partnership Buslness Telephone 617-246-0019 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Clifford H. Giles INSURANCE COVERAGE: I have eyes ent liability ns 0 ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. 9 you have checked yes. please Indicate the type coverage by checking the appropriate box. A IW Aity Insurance policy CK Other type of Indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: 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. Check one: nature of Owner or Owner's Agent , Owner❑ Agent O hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in complienoe with atl PwUnw t Provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws ey �— T e of License: Plumber Signature cen um r diet � Gasfiiter Master License Number 8701 APPF ED t Journeyman 0 i. J N X m A x m w 40 Date...'.. 2.: ............. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................ / ................... has permission for gas installation ........................... ...................................... in the buildings of co W at ..... ; ............. ................... No"do�ver, MOS. Fee.. .... Lic. No........... . ....... .... .. o," ir, I GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer