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Home My WebLink AboutMiscellaneous - 104 CARLTON LANE 4/30/2018 (2)Date1l.. • ~^ + TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....,/.--, %- .......... has permission for gas installation ..... , ` , , , . , , . in the buildings of .... �� 1.�;. ... , , , , , , . , at.. ... /f,,. / , �....�/.. , .... , North Andover, Mass. Fee .s&.A.c .. Lic. No. / I�jr.fy� ..................... .. . GASINSPECTOR Check # SS's J 711z' atflle2_�'k P I -e- _N_0 \1 i MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK - CITY ,-•._. ._._ 11,._i'1:...,ralr,l�;�:..�:.�:�:•..--� .�1 MA DATE ./�' /� %�PERMIT# JOBSITEADDRESS��!� OWNER'S NAME 4=1 - ff OWNER ADDRESSV TYPE OR IPRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL[ CLEARLY NEW:Rf RENOVATION: -1 REPLACEMENT: PLANS SUBMITTED:YESEI NOZ APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER h. .. - k.L:.._ i- . _moi....... _: I__::•._.._ I. BOOSTER !-�! II—? CONVERSION BURNER F—. F- �_'(.. :_�rr~► ----k—_r.--r—, COOK STOVECT. '..~----i_—� --;-- :----;C.. I_ I-.. — :..- __ : DIRECT VENT HEATER (` L :[!r F--:1 j --> —r-- DRYER — f�- FIREPLACEI .-..:....I- FRYOLATOR : _. FURNACE7.7=77- - -- - - �^ -r- GENERATOR GRILLE INFRARED HEATER. _ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER_-- -._ ROOM/SPACEHEATER i�'�;=f F-. ROOF TOP UNIT L !`.—, TEST UNIT HEATER r UNVENTED ROOM HEATER k�� 1-7. 1...,�.... -k�_C WATER HEATER !_ ! I -- OTHER . - !��..��.�:w;�w�,._,��;n._M INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 10'NO { I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND P 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 flue a 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 compli e wi all PertlQ provision of the - Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME U LICENSE # SIGNATURE MP 0 MGF EA JP Q JGF 0 LPGI CORPORATION R# PARTNERSHIP C1# LLC F - COMPANY NAME: s / ADDRESS CITY i rc STATE %`!= ,1 ZIP D 3 TEL FAX _. _.... �)L..:EMAILE 711z' atflle2_�'k P I -e- _N_0 \1 i . . . / t § m / \ } / / z `§ \ . > j' 8 g. j 4 ¥ o / 4 \ / 2 � CD \ ` .0 / q0 . \ \ / n l 0 a \ . ) � w cn cn m Town of North Andover Page 1 of 1 BC -0. aas rameea�P j. lrgca.rorrr+m an -p Ut"-Ms=bmyra M mumy.. mom -em + t �/^� a�awr�ame CeoP�ooic a«,mam5y�nfa4tu®aamy�erdsa s*��n. rreaaamsRp uts arPffie®epmecawm einH'mn nzsw 9a..1 �-^ �vCealgm4refiesvPr. %~e.bra,:aaae�ssede8ls,.ue poo=tY e�taP�Tra repnenmmA��ctivaYYP��6[tmml�nn.WwSs {��j Y491+�r �ed�ns axamClaio:8^.Wv�p9:fCJ C7+�1cCmrs�e,.empt,eRienn3.hWr'4y VlanM�g larm'aC�b cereal AatBnWc�nC`+armticS¢ afae+sn�e c>,.+armexa rtiomsuoa MyuKdmstgrracun igeteeretipnn9wn rtsk ;Select (show all) Owner.Pr op_1D SULLIVAN, TIMOTHY; 106. C-0096-OOOO.D 1 selected To Mailing Labels To Spree Owned SULLIVAN, TIMOTHY Owner2 SULLIVAN, DEBRA Address 104 CARLTON LANE PropertylD 106.C-0096-0000.0 Lot Size 1.46 A Fiscal Year 2013 Land Use 101 Code Last Sale 11/05/2004 Date Book/Page 9171 Total $556000 Valuation Building CL Type Year Built 1982 Pla Li+._. / -- -- — - ....,_ TT-. 11- A .- A -•_--.._....-.,.._ A Z. --- ..---- 1 n /1 17 /11 /Y1 11 Town of North Andover Page l of 1 � NmS�YfHrumnB OonrKSlafticesr¢m¢*eaM µeapesetlaa�t'ca,nmz�are ary eBd tiouyare�ast�yram: ack�rcaq. npryiCanes, auxfn+�atl Te Gmgancnb:s�Ks�oeuaamorermrsavn�te�. t�aau msnaememeo�maane��onm a�nevmie n. 'm m rean+g oe w—fiPA9Ca.ispamatyjmt ae ss+gaWctn "mfflr vawatiw rtpnartavo•Nsramx"6 GumWgCarmtxa+rtWm.As y ara++"OWS MIDft JM 0Gap0¢�s rft Ma AM Mb VtS" rdW is WO Ptlmdq CAmdT.bt§tereeimaedmek9m mmrksa nfaBpJaa91a66bha6YlaM0t4aC rramaaai arm ua?OCiG klgmafWt$8hri�'7i tiU0%A NSY. �3D L:�)u Selection ( Legend Location (� M i Select ....... ........,..� (show alp -- - - - -- - -- - - (Owner Prop_IO ,SULLIVAN, TIMOTHY' 106.C-0096-0000.0 1 selected To Mailing Labels To Spre. I � Pia Ownerl SULLIVAN,TIMOTHY Owner2 SULLIVAN, DEBRA Address 104 CARLTON LANE PropertylD 106.C-0096-0000.0 Lot Size 1.46 A Fietal Year 2013 Land Use 101 Code Last Sale 11/05/2004 Date Book/Page 9171 Total $556000 Valuation Building CL Type Year Built 1982 11/17/7n11 GENERATOR "APPLICATIO4 DATE: LOCATION: rG�� ZU� e r-- OWNERS NAME: GENERATOR kws�� NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: 44el-11611 "1 1/1 PHONE NUMBER: CD3 3joo�'�0�3 ELECTRICAL I OGAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: Au *CONSERVATION APPROVAL U� i ID , (I CJ%� ko� � &W I i I- i, I Till [ell ii -A i'v'. I 'III- Awl I klill"ime"i glt,-J� DATE: LOCATION: ��% 7 �� -J �r ` • �'/ OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: %I-ew'G"�'^�� PHONE NUMBER: CCAL TIAL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: ` x�- = �.-N't,,A Vy- V9,44, *ZONING DISTRICT: *CONSERVATION APPROVAL , 4,.,om �j �J�m Lkti I DATE: LOCATION: �U7 ��e�0^� �r. N'T /k�� OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: Iw'E'''�� PHONE NUMBER: EL CAL RESIDENTIAL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *CONSERVATION APPROVAL��=� �� Date 101741 . � 5Y �.J�•s�. ` TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that�.,.,. e ..... ........... . has permission to perform o�jP^��:7�?/�- . wiring in the building of 71`u.� � /�! . ,.! ..................... . zat../.. n........, N Andover, Mef ass Feer. Lic. No.......... !`%-"" .. ...... ... . VCj do ELECTRICAL INSPECTOR Check # Avae // /q 11168 ? Commonwealth of Massachusetts Offi � I i sp� Only �(y Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 527CMR 12.00 (PLEASE PRINT I7V INK OR TYPE ALL INFORMATION) Date: / e City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) I e '1 Owner or Tenant T/ Ak S U L G j VA N Telephone No. Owner's Address /04 C A- A)- `ro/V L A/VIC Is this permit in conjunction with a building permit? Yes ❑ No M (Check Appropriate Box) Purpose of Building a W 0 it /r u G- Utility Authorization No. - Existing Service 10 G Amps i /0 / 4-0 Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1/\/ S 7 A G L /0 k- AUTO N1 A ; l G G �9 5 fir- A +7 0 lZ /'.,,H.,rof;nm -{iho fnnnu» vro tnhly may he waived by the Inspector of Wires. Arracn aaairionat aeum y aemreu, Or ua . -q— �u y .•.� .•• r�� r -- Estimated Value of Electrical Work: 0 -ad. ert (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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:) Icertify, cinder thepains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: M )5- fl I'i l 1vt A10 k H Y A C LIC. NO.: Gf M Licensee: %Q I C HA N R M � 1 yG 0 U .� Signature s% �j - LIC. NO.: 5/ A (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603-9-;1,17 Address: —61, S H OZ ryx i V T S A w E^1 Al H °�' 0 7 i Alt. Tel. No.: G03 g f3 li'7'05 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lic. No. j' u� R 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 PERMIT FEE. $ 04-M.— Telenhone No. No. of Total No. of Recessed Luminaires No. of Ceii. Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool rnd. ❑ rnd. 10 o. o mergency ig tmg No. Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices Hear Pump Number KW No. of Self -Contained No. of Waste Disposers ,Tons Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW Municipal Local 0 Connectron E] Other Heating Appliances KW Security Systems:Y E No. of Dryers No. of Devices or uivalent No. of Water, Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Egli ivalent OTHER: _ 71,..x1.,,T--fnr-rwirpv Arracn aaairionat aeum y aemreu, Or ua . -q— �u y .•.� .•• r�� r -- Estimated Value of Electrical Work: 0 -ad. ert (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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:) Icertify, cinder thepains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: M )5- fl I'i l 1vt A10 k H Y A C LIC. NO.: Gf M Licensee: %Q I C HA N R M � 1 yG 0 U .� Signature s% �j - LIC. NO.: 5/ A (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603-9-;1,17 Address: —61, S H OZ ryx i V T S A w E^1 Al H °�' 0 7 i Alt. Tel. No.: G03 g f3 li'7'05 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License. Lic. No. j' u� R 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 PERMIT FEE. $ 04-M.— Telenhone No. f ._ •.1�1.AiJtJ�AJLw-1.•�y{-{��•�}{�,d.1!7�11�(yJ-y'RA��y��®��fr'P��Qp(;}��(• p/�p ,�5,�{N.4 �`UJL.*.�.Ll �®�•`��•i � r 'asseci-- j) Mad—[ �s,�eeioxs' colnm.enis: cingeetoxs',pigrmi m-•x.oidflaxs) pate I'siled { specto7rs',Higaawe- io}ni€ia7s) ` 0MCWON-OM+Rt ' Pate eEl--[)aiier- [ )_ ateas�ectioa xec�uize 00.00) - [ - btu sp ectoxs°zgxtaiure 0 7ini �zaTs) date - - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UT. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) Address: 6 6 S He Re City/State/Zip: /V►FR R/444C k- , PRIV F 5Al✓rA� Phone #: A G Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its rPffquired.] 3. ❑ I`hm a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] /V _H- 03 a 7F Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance,Company Name: S AN VO IN 5 V fA l)l C Policy # or Self -ins. Lic. #: G/ 5 M k Expiration Date: 1 Job Site Address: 14 CA R L 0- Ta /V 1,4 N F 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 :)f 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. C do hereby certify under the Dpains and penalties of perjury that the information provided above is true and correct. Signature: �G r Date• /O /2-4 1112 - 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. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 -contractors) 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 carry 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. Also 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. 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 permit/license 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 burn 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 4 617-727-7749 www,mass.gov/dia