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HomeMy WebLinkAboutMiscellaneous - 114 OLD VILLAGE LANE 4/30/2018 i i vv Date....dtt.,1..'...7....................... °�r1°wrly, TOWN OF NORTH ANDOVER O � 9 PERMIT FOR GAS INSTALLATION 88ACHus� This certifies that .......�! !! . has permission for gas installation k2. ... . . r..[�.�a '"/ ...... inthe buildings of....................1................................................................................... .. ... F-1. . No A//dover, Mass. Fee-.. '✓.''�......... Lic. No. ...... ...... ....... . .'...., ... pp1�................................ AS�NSPECTOR Check# 9673 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s CITY I North Andover I MA DATE 11/18/2014 PERMIT# JOBSITE ADDRESS 114 Old Village Lane OWNER'S NAME I Victor Fleury GOWNER ADDRESS ITE IFAXI TYPE OR OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES[j NO E] APPLIANCES 1 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 2 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 1 OTHER Jill 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 [D 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 7aiveu qnt. CHECK ONE NL�. WR _ AG T SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this ,plication are trjFCth ratrd o the est of knowledge and that all plumbing work and installations performed under the permit issued for this application vii it e in a `rti n provi on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 3 PLUMBER-GASFITTER NAME I Timothy A Giard LICENSE# 10301 IGNATURE MP[j MGF® JP® JGF® LPGI® CORPORATION®# 3443 PARTNERSHIP 0# LLC®#� COMPANY NAME:j Timothy A.Giard Plumbing&Heating Inc ADDRESS I P.0 Box 782 CITY I North Andover STATE=ZIP 101845 TEL 978 689 8336 FAX 1978 689 8300 j CELLI 978 490 7108 EMAIL tgiardplb@yahoo.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL L IN PECT N NOTES Yes No i THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date. �..l. 7 7 b NORTH pf �.,o ,41 o� °` TOWN OF NORTH ANDOVER a - PERMIT FOR GAS INSTALLATION 9 SAcNUSEtt 11 �1 T • This certifies that S.6o(.S',r►:'1-.�:t!t. . . . . . . . . �. . . . . . . . . . has permission for gas installation . .eA rj-,<.... . . . . . . . . . . . . . in the buildings of . ,N4,4!d71 v . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .f�// v� �l��19��.,j N rt Andover, Mass. FeeV. . . . Lic. No.. f�i GA NS OR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:;u 4-/vr MA. Date: , q Permit# Building Location: { �'}�� (� ,� �6',iw Owners N l e � �iS Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential Q New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No❑ FIXTURES W co Lu cA U = Z Q co 0 F m = FO LU w V CO H O = W w z z 9 z o � Lu O Q w > M v Z w z Lu CO Lu o _ UJ O W W Q = x Z LL N J m H H O Z J (� LL = W F— W W W L) LjjZ -.1 U D l=L C7 O _ = > O Z L 9 O W Z Z W Q I-- SUB BSMT. BASEMENT _ 44� 1 FLOOR 2 ND FLOOR Ty--FLOOR 4 FLOOR i 5 FLOOR ' 6 FLOOR 7 FLOOR 8 w FLOOR > Check One Only Certificate# Installing Company Name:_S.4�5 iviAh `IJj(; ❑Corporation Address: ' ` AMtS �C City/Town: vcl _ State: ' [I Partnership Business Tel: ,]�! ( "CITQ( C?5 J Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes Z21ho❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of 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 Signature of Owner or Owner's Agent Owner El Agent E] By checking this box❑;1 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. fJ' Type of License: / ~ By ❑Plumber / Title ❑Gas Fitter Sin ture,6f Licensed Plumber/Gas Fitter ❑Master City/Town ®Journeyman L_ APPROVED OFFICE USE ONLY ❑LP Installer License Number: I '� Com° PLUMBERS A ` LICENSED AS jo RNEY A. PLUM ISSUES THE ABOVE LICENSE T � r :GEORGE SALSMAN JR t; STI JAMES RD II' S'AUGUS MA 019.06-4.06'"'. 31636 05/01/12. 800038 , i i 9067 Date. .6-?�2 NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA US This certifies that . . . . . . . has permission to perform plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . �� !�.�1 .vA.�/. (. . rth Andover, Mass. Fee.yl�S. . .Lic. No, �(p �. . . . . . . . s PLUMBI INSPEC Check # _ i ff MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: � ✓rQ l MA. Date: /`a y'�/1 Permit# Building Location:- C/ � / f� � L X I j r �.0 f' Owners Name: 1 Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential❑v'i New:[] Alteration:❑ Renovation: ❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED H Z; SYSTEMS Z ti w y, O V) Z H N O cn nom. a z FQ- U �y- w D O O m y w Q Ln LU ca Ln } iz Q h Y O F" N Ln w ~ Q Y ~ O z w p H Q w z w � z U ° LL S Q Q U 1- H v_ai O I- U j Q a Y z S w w w 0 O � � LU a Q L"L O F- O O N < 1- N w } F- a m m o o LL x ,� g g `n 3 3 3 0 ° N SUB BSMT. U ( 3 BASEMENT 1ST FLOOR f 2ND FLOOR 3RD FLOOR 4'FLOOR ST"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR r Installing Co�iipuny Name: ` '4 M at'0 , fz Check One G'nl Cart!ficate 1z Address: EJ Corporation �., �3 �N'1 r j � City/Town: S" r,,`5 1/]/y i State:'"I�'�" Business e. ❑Partnership Tel <2 03 Fax: ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial tial equivalent which meets the requirements of MGL.Cjea �oE If you have checked Yes,please indicate the.type of coverage by checking the appropriate box below. A liability insurance policy.❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required bMassachusetts General Laws,and that my signature on this permitapplicaion waives this requirement. Check One OnlynafureofOwner orOwnet'sA ent Owner ❑ Agent hereby certify that all of the details and infmation t have submitted(or entered)regarding Phis IIE are true and acc Knowledge and that all plumbing work arid"'installations performed under the permit issued forthis application will be in compliance owith all t of my Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑Plumber Signature oVLicensed Plumber �itylrown ❑Ma`ster y 4PPROVED(OFFICE USE ONLY) Journeyman License Number: ,� � �..J f Date...... .. NOR7/y O�t..ao;a 1ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� This certifies that �/U(�!P��•v �"��!/��r � ........... . ............ . . ............... . ........ has permission to perform .......`.l..L. yt/............................................ wiring in the building of 6 4- a at...�.J .. L f�../�(. l<s ,,fes,. ....4 .............. . orth Andover,Mass. Fee,5P- :-:':= 9.SP 777 i ELEGTRICALINSPEC Check # gql -5 Conurso�Lcvea�tlti o���1a��ac��«selld M'Ilciul l)sc Out Permit No. le 2eP artmen.1 of Jire Servilcea Occupancy and Fee Checked BOARD OF FIRE PREVENTION.NEGULATIONS [Rev. 1/071 (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 IN INK OR TYPE ALL INFORMATION) Date: '] I 012-00 City or Town of: ill (4otjaloVEer 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) 1 L4 Cif VJ*L(.p-&C (,A_j Owner or Tenant Vic-ToL ,(L-Fol" Telephone No.9'2l-7(.0 "ZoV Owner's Address 114 00 ut cc A4-c (rte � Is this permit in conjunction with a building permit? Yes � No ❑ (Check Appropriate Box) K Purpose of Building 065 1 b 6niCtr Utility Authorization No. Existing Service 2-W Amps (?O / 240 Volts Overhead Undgrd ❑ No. of Meters 1 New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders acid Ampacity Location and Nature of Proposed Electrical Work: � Me i,4--ale AJc1 i #—!a tai-QT T-G F1!�to c y t ovf w Qc3v�-t , fC/eta lotf to r ok e.P?rte& wiit,t tt,& !7Y A-Aa doe-# , om letion o the ollowin !able m be waived b the Inspector o Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fo Total r� Fans TTrransformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA Y No. of Luminaires Swimming Pool Above ❑ In- Elo. o mergency Lighting rnd. rnd. Batter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No, of Switches No.of Gas Burners No. of Detection and Initiating.Devices No.of Ranges No.of Air Cond. Tonal No. of Alerting Devices No.of Waste Disposers Heat Pump Num...er. .Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection Heating Appliances Security stems: No.of Dryers g pP KW No.of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent a No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: . � Attach additional detail if desired, oras required by the Inspector of Wires. Estimated Val4CVERAGE: EleNoll cal Work: (When required by municipal policy,) Work to Start: 10 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE 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:) I certify, under the pains and penallies of perjury, that the in urination on this application is true and complete. FIRMNAME: C CAA4r15-"A 3K rP4&1 t` LIC. NO.: CS6777 Licensee: !- KeAl e oxiv-&JL' Signature LIC. NO.:ESO 77"7 (Ifopplicable, enter ` x m t"in the�licef'se numbe line. Bus. Tel. No.: •?71 7f Y ddress: 37 � Cl: 1[�1 l, t'"6� 1 K6_ ©(�{' .tF Alt.Tel, No,: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safet}, "S" License: Lic.No. C5567,77 OINNER'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, PFR MIT 1, ,E. v� 527 CMR 12.00: 2008 MASSACHUSETTS ELECTRICAL CODE (AMENDMENTS) The Massachusetts Electrical Code (527 CMR Rule 6. The approving authority may be guide 12.00) of the Board of Fire Prevention Regulations shall be the National Electrical Code modi- equipment in his approval of specific items of >�.a. e ment and materials contemplated � 0,0� (�1� ����) p by the Code, by proof that such equip- fied as follows: Insert the following provisions ahead of the body of ment and materials have been tested and the Code: conform to suitable recognized industry Rule 1. All installations, repairs and mainte- standards. nance of electrical wiring and electrical Rule 7. 527 CMR 12.00 shall be effective on all fixtures used for light, heat, power, sig- installations for which a permit has been naling and communications purposes in granted subsequent to December 31, buildings and structures subject to the provisions of M.G.L. c. 143 shall be rea- Rule 8. In accordance with the provisions of sonably safe to persons and property. M.G.L. c. 143 § 3L, the permit applica- Rule 2. Conformity of installations, repairs, and tion form to provide notice of installation maintenance of electrical wiring and of wiring shall be uniform throughout the electrical fixtures used for light, heat, Commonwealth, and applications shall be power, signaling and communications filed on the rescribed form e= with applicable regulations set forth in ,:= s pp g filed with the ` �eu to gi. the Code, which is hereby , 4 R Secretary of the Commonwealth shall be �p b� � ��� r�colluo„ia i considered as complying with these re- ell , _ p �€P quKU irements. ' Rule 3. Additions or modifications to an existing � 1� r�Sp4r�s1, installation shall be made in accordance We fol"tM M ar_o k©tfi lek d lgg � with this Code without bringing the re- e maining part of the installation into �. � � %,��,� compliance with the requirements of this ,� v � tf� Code. The installation shall not create a rMffl� ��� 4 �� � violation of this Code, nor shall it in- es6 h magnitude of an existing vio- crease the g g15f 'M lation. to Rule 4. Where an actual hazard exists, the owner e pa s Y� d� ' of the property shall be notified in writ- ptldiyY,�re, atit�h ate, jra2c, S'tc $i T k ,�;�' R RC1's.4} ✓4�. mg by the authorityenforcing this Code. tions"�3A�n hd tri lir coni l f16 f wUxk g zrx 3 v x7 N d mY w 4 , Ile nOt�if Catlo�rSa�1 Co2ltarn 5 f ClfiCcl n s s x + sralleered far rrana �case, tions t► llaectaha�a thateit toy "I"W� a-,,11.tb?gti� t M d s R {rcj Y y.cxa, 3YY+� �'""a v ge*1 e tiwit r a refe ei ee to fie ru e d W'P qudst o e`t �r i' ow 4 or tkrd Code tt rs] novo; m U vtoat�on. (See r erittyyst5atc obi tk� upe1'riart ap M.G.L. c. 166, §§ 32 and 33, for en- plieon covered b forcement authority.) Rule 9. Installations y 527 CMR 12.00 comply shall also with M.G.L. c. 141. Rule 5. References are made m this code to p Y other standards. Those standards, where Rule 10. Electrical installations shall not be con- duly adopted regulation, cealed or covered from view until in- be enforced by the appropriate official. spected by the inspector of wires within They are not considered part of this and not more than 24 hours for exterior Code and they are not enforceable under excavations nor more..than 72 hours for � A M.G.L. c 143 § 3LorMass'aehU-selts. interior installations after proper notice Bail°d rn ;Co;deget' ��"" e `1pp.,- en1r to the inspector, Saturdays, Sundays, and ,g A holidays excluded. The Commonwealth of Massachusetts Print Form Department of lndustrid Accidents Offiice of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mms gov/d& Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Apulicant Information Please Print Legibly Name(BusineworganizationMdividual): AL eke", �- Address: -17 Ifet City/State/Zip: 0'?4:(/ phone#: 97 F- 77/ -7/SY Are you an employer?Check the appropriate box: Type of project(required): 1.O 1 am a employer with Z- 4. ❑ I am a general contractor and I employees(full and/or>?art-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers'comp.insurance comp.insurance.# requite] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions self o workers'coo right of exemption per MGL �' � P- 12.❑Roofrepairs instuance required.]t c. 152,§1(4),and we have no 13. Other I ❑ employees.[No workers comp.insurance required.] ;Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an enrloyer.ihat is providing workers'compensation insurance for my employes. ;Below is the policy and job site information. r� J Insurance Company Name: 6,4, �{ --rN q o rz"t✓t5 U---i—mop Policy#or Self-ins.Lic.#: A IV WC d S G 8 25 Expiration Date: Z h tt l za i z Job Site Address: ( 14 Of b V)LLA trC C.Aayl_ City/State/Zip: 1✓ A&dove-c HA 0 IRIS 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 foe of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do her c u e airs and Penalties o e ' that the in ormadon provided above is true and correct: Si ature: a qtr Date /O Phone#: 7�� OfJ`wW use only. Do not write in this area,to be completed by city or town o f)Acid City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: c� % Date. �!.-�•�!.. .... r� Npa TOWN OF NORTH ANDOVER g Of�.,,a o •e 1't'O 3? '� PERMIT FOR GAS INSTALLATION N p • • .moi o+no^r�`M1h SACHUSEt This certifies that'0?? n.. .... . . . . . .. .!. . . . . . . . . . . 0 . has permission for gas installation o in the buildings of . . . . . . . . . . . . . . . .o. . at . . . "Z . . . .: . . . '. f-1 :P ,.North Andover, Mass. Fee Lic. No��6� ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Y Ll 1 7 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING Type or print) Date / 19 NORTH ANDOVER, MASSACHUSETTS r� l OL�i C C fr-/� Permit#��9 Building Locations Amount$ Owner's Name New Renovation Replacement Plans Submitted n u C W Z CG w E- W F. C A. tn GC rq C ,-�c U W x W W r W �' C �d u a .. W F .; t i- � � z C Z w F V C, y ,., i C W C z '� G V 'i v C > F C CL w i •.• SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2N D . FLOG R 3RD . FLOOR 4TH . FLOOR 57 H . F L O O R 6T H . F L O O R 7T 11 . FLOG R 8'r 11 . FLOOR (Print or ty�e),,� Check one: Certificate Installing Company Name �`"P IL l�� �/�Tl.. Corp. Address E —Partner. Business TelephonedZ Firm/Co. - Name of Licensed Plumber or Gas Fitter �7✓G � A4 c n INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0-- No❑ If you have checked M,please indicate the type coverage by checking the appropriate box. Liability,,*,nsurance policy Other type of indemnity ❑ Bond ❑ 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse Code and pte of al Laws. By. Signature of Licensed Plumber Or Gas Fitter Title ED—Plumber City/Town ❑ Gas Fitter License Number �1Glaster JourneymanAPPROVED(OFFICE Use ONLY)