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HomeMy WebLinkAboutMiscellaneous - 12 KINGSTON STREET 4/30/2018 / 12 KINGSTON STREET -21-0/023.M004-011-9-11 Date..�!.��tJ�.. .. .... .. Of`NORTH o� TOWN OF NORTH ANDOVER n ' -PERMIT FOR GAS INSTALLATION SAC HUSESSy S This certifies that . .TP , !C *r. . . . . . . . . . . . . . . . . . . has permission for gas installation . .�?�?1Gf?nvn . &!4.r. . . in the buildings of . .W41gk. Breen. .4w at . . . . art . �o�.s�T ti 'k% . ., North Ando/ver,, Mass. Fee.:�.�. ca Lic. No.. /l�4`���. . � ✓. ?' . . . . . GAS INSPECTOR Check# ZZS-T 7988 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:) . Af"30y-eA MA. Date: \ Permit# r Building LocationA1,\A.AbWI23 5 Owners Name:V Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: ❑ Replacement:DQ Plans Submitted: Yes❑ No FIXTURES C6 Z W U 2 m (7 J O ~ (A 0 2 W W p W W W O w N Lu m 0 Q a � Cl 0 w X to > W Z H W W _ W F' a W W w Z cn = CoW z w V W Z O J I- I— 0 Z -� U' N W I— W W Z LUO W Q W W m W 0 Z 0 y > Z Q H v o o LL C7 0 x = J 0 a H > > > O SUB BSMT. BASEMENT iJ --i'FLOOR 2 No FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name:V)l._. ,uviQeS � ❑ - Corporation AddressW Wx y � City/Town: ��cj �y Stater ❑Partnership Business Tel-- $1 X16-SBF Fax: firm/Company Name of Licensed Plumber/Gas Fitter: C�< INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YesR No❑ 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 Owner ❑ Agent ElSi nature of Owner or Owner's Agent By checking this box❑;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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By KLPlumber Title ❑ Gas Fitter Sign re of Licensed Plumber/Gas Fitter E LMaster City/Town ❑Journeyman License Number: APPROVED OFFICE USE ONLY ❑ LP Installer 9246 Date.11; 117- TOWN 11z...TOWN OF NORTH ANDOVER Of "•O '•1�0 PERMIT FOR PLUMBING SSACMUS� This certifies that . . . . . . . . . . . . . . . . . . . has permission to perform . rwo.. . /lop�rT. plumbing in the buildings of . 111.44grZ-. .� at . ./ l .,t�l. .5 �c%ht►. - ., ., North Andover, Mass. Fee. �J!?�!.Lic. No../�Q01 ./ Cry. . . . . . . . . . PLUMBIN INSPECTOR Check # 7?_ 3 _ MASSACHUSETTS UNIFORM"pLICATION FOR PERMIT TO DO PL UMBIlVG (Type or print) NORTH ANDOVER,MASSACHUSETTS \\ Building Location 1 Z \,A� �Vo \3'� `z-D \(�� p� S� Date p � Permit tf Owner Amount SSbC New ❑ • Renovation Replacement Plans Submitted Yes No FIXTURES H9S�.VIIv1' ]S>C IIDQt ! Ztil< E[OM 3M ELOM 4M ELaR lut". 6M FUR 7IH IID(R 9MRIM (Print or type) Installing Company Name_ D+1- : ,k"1 C-P 5 Check one: Certificate Addres90 ^ �3 El Corp. s X C` yP, 0 ❑ Partner. Business Telephone --lg� Firm/Co. Name of Licensed Plumber: Insurance Covera¢e Indicate the type ofinsurance coverage by checkingthe a Liability insurance policyEl Other of indemni appropriate box: t3'' 13 Bond ElInsurance 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 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 rith a pert' int pro ' n�of the Mass hus tts Stattee Plumbing Code and Chapter 142 of the General Laws. By: ., +z,c�,� ` ngna O-Mi—censdu riumoer Title Type of Plumbing License City/Town �-n APPROVED(OFFICE USE ONLY rcense um �r Master ,Y 1 Joumgman ❑ The Commonwealth of Massachusetts Department of r ndustrial Accidents Office ofInvestigations . ..600 Washington Street Boston, AM 02II1 WWW-Mass ovldia Workers' Compensation Insurance Affidavit: Builders/Contz actors/Elec ' A licant Information ir;<cians/plumbers Name(Business/�ganition/Iridividual): L please Print Le ibl Address: QO �k City/State/Zip:P� k`RA ©wc1 O Phone#:_TS -,I 6-�%) Are you an employer?Check th I am a employer with eappropriate box: 1•�, 4. [] I am a general contractor and I Type of project(required):" employees(ft and/or part-time)*• have hired the sub-contractors 2.❑ I am a sole proprietor or 6• New construction partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-:contractors have working for me in any capacity, workers com . ' 8• .�]Demolition [No workers'comp. P Insurance. P insurance 5. ❑ We are a corporation and its 9 E]Building addition required.]. 3•El.I am a homeowner doing all wofficers have exercised theirork right of exemption per MGL 0:❑bElectrical repairs or additions myself. [No workers'comp. C. 152 I 4`lambing 1epairs or additions insurance required.]t employees., ),and we have no 12-0 Roof repairs . [No workers P comp.insurance required.] 13•❑Other *�3'applicautt chec_W bo 41 must also Homeowners who submit this in out the section be?oi=,,shoe . affidavit indicating they b- s wow=•cor ps.•sa�on poLcc}.information. $Conhactors that check this box must attached an additional sheetshow k and . thethen hire outside contractors must submit a new affidavit indicating such. I �MP[oyer that is providing workers'compensation insurance form e3aame of the mctors and their workers'comp•policy information. inon. y ployees Below is the policy and job site Insurance Company Name: ��C�r�'��S-� �S�S�c��G Policy#or Selff ins.Lic.#: Expiration Date: Job Site Address:l 1k) 16 Q Sit,, S� Attach a copy of the workers'compensation policy declaration�a City/State/Zip: �l, �4ONen Failure to secure coverage as required under Section 25A of MGL C. 152 nano lead to the the imposition olicy n bot c and expiration date). fine up t$$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WO Of up to$250.00 a day against the violator. Be advised that a co criminal penalties of a i RK ORDER and a fine Investigations of the DIA for insurance coverage verification PY of statement may be forwarded to the Office of I do hereby certify under the pains Sienature: and penalties o er'u fP J rJ that the information provide above is true and correct cY� Date.: Phone#: Official use only. Do not write in this area, to be completed by city or town official � City or Town: Perri t/License# Issuing Authority(circle one): j L Board of Health 2.Bud 6.Other ding Department 3.City/Town CIerk 4.Electrical Inspector S.Plumbing Inspector b Contact Person; • Phone#: ' a603-893-4260 "<;` 1-800-637-2366 NEW ENGLAND RADON, LTD. 373 Main Street Salem, New Hampshire 03079 i LABORATORY ANALYSIS RESULTS { DATE: October 1 , 1988 RADON RESULTS FOR: Terry Nevans Village Green Condos North Andover, MA 01845 TEST SITE: Al & Murtha Ginsberg 12 Kingston Street North Andover , MA 01845 Code No. Cp i/L Location ' 6741 2. 7 Basement The result of this measurement is below the protective action guide (PAG) recommended by the EPA. No further action is indicated. A reading below 4 pCi/L for your screening measurement if made with the house or basement closed-up prior to and during the testing period (as specified in the instructions ) indicates that there is relatively little chance that the radon concentration in your home will be greater than 4 pCi/ 1 as an annual average due to airborne radon seeping through the basement.