Loading...
HomeMy WebLinkAboutMiscellaneous - 120 MILLPOND 4/30/2018 120 MILLPOND 210/095.A-0120-0000.0 I i NORTH 0�.,,LSD tet A Town of North Andover �D D.B.A. —Zoning Compliance Form T:o�" � 978-688-9545 saCHus This form must be reviewed with the Inspector of Buildings. Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday. Applicant N Name of Burins Address of Business: Zoning District Map lY�t 5 Lot (p Phone: Email Nature of Business Do you own this property? Yes No If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes No Will you have any major deliveries? Yes No Description of Business Activity(Must be Completed) &"Signature of Applic For Signage Refer to North Andover Zoning Bylaw Section 6 The propose is an e se ' t 's oning district. / Issued By e Date..... ....`'.. �?e/1 ............ 4 r10tiTl� °� "`° '•'tic TOWN OF NORTH ANDOVER PERMIT FOR WIRING 183��5�t This certifies that VY1 has permission to perform .�;!��: �?i�.I..'e f .1................ �................. wiring in the building of...,.".�.�° ,;,!"�'". �-- . ...n................................................................... +� ��. at ........ t ...........G. .......A...�....................... orth Andover,Mass. Fee.. "'..........Lic.No.2 ,,.1 ...1"L ......... ............ ELECTRICAL INSPECTOR/ Check# 11560 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I �4 - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Occupancy 1/07] cave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 11 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: `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) !a 0 /4 ; (I Po N An d e u e. Owner or Tenant F s ; c S c,Li yi L <' e ✓ Telephone No. 17of-SO S�3 Owner's Address ( ;,o_ Jkl t ( I P o n t Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Approprlatetox) Purpose of Building 1�' c S r J s`^ < t Utility Authorization No. Existing Service. Amps / volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / volts Overhead❑ Uudgrd.❑ No.of Meters Number of Feeders and Ampacity F Location and Nature of Proposed Electrical Work: a T X /V• w n u 71-4 i S Completion o the ollowin table ma be waived bil the Ins eetor of Wires. No,of Recessed Luminaires No;of Ceil Susp.(Paddle)Fans r o Total Transformers KVA No.of Luminaire Outlets No.of Hut Tubs Generators RVA No.of Luminaires Swimming Pool Above ❑ n" ❑ o.o Emergency Lighting rnd. d. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS EO--Of Zones �18t Switches No.of Gas Burners No.of Detection an InitiatingDevices No.of Ranges ''tt „ No.of Air Cond. TotTons. No.of Alerting Devices No.of Waste D.P(Osers eat Pump Number ons KW o.of Self-Contained Totals: Detection/Alertine Devices No.oshsvasConneectio f-bihers Space/Area Heating KW L6ca1❑ unfctio n Other ❑ .r_ No.of Dryers Heating Appliances KW Security ystems:� ry No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Sims Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Tel l Too.of Devicesoor E ufvalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: e-/ 3 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 b OTHER ❑ (Specify) I certify,under the pains and penalties e f per1g/ry,that the information on this application is true and complete. / FIRM NAME: T'o. m e s Tr c9 c. t LIC.NO.:V1 01gPJ Licensee: TO.V"-.S T r t Signature �� '/ LIC.NO.: (If applicable,a ter"exempt"in the license number line) Bus.Tel.No.- -7 r- fI Pdr-3'3 d/ Address: 18 •l ✓ l c 5 T• c/ �► v IQ t-/ 030.7 � Alt T&No. 2'7&7- s°/ *Per M.G.L c. 147,s. 57-61,securi work requires Department of Public Safety"S"License: Lic.No OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance-overage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a it. Owner/Agent Signature t Telephone No. PERMIT FEE:$ �� ti 1 .y AS A REG'J0URNEYMAN ELECTRICIAN r' ISSUES THE'ABOVE`LiC,ENSE�O ,�, r 'pog - JAMES R ¢TRUDEL ; :. m r fi r ? �N X19 a=BERKELEY ST PEHAM'_ I X95. E 01/31/13 y8:36D2 �►r n tiz _ I i i i The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatiorAndividual): _,J ct vo -e 1 ✓ t'L L Address: City/Statq ,-n �V f 1 Phone#: / d ✓ Are you an employer?Check the appropriate box: Type of project(required): general contractor and I 1.El I am a employer with 4. ❑ I am a g 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors k2mm a sole proprietor or partner- listed on the attached sheet. 7• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. F1We are a corporation and its required.] officers have exercised their 10 E]Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance employees.required.]t loyees.[No workers' 1311 Other 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 aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 thepolicy and job site infigrmation. Insurance Company Name:. PoAcy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 requiredunder 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 cert under the sins and enal' s ofperjury that the information provided above is true and correct. Signature: r % r Date: l 7 Phone# / -7 a 573 G 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#: ' y 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." j 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(ifnecessary)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 bum 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 Stxeet Boston,MA 02111 Tel,#617-72.7-4900 ext 406 or 1-877MMASSAFE Revised 5-26-05 Fax#617-727-7749 �rFcsn7r moon h..rzF.1:.. Date. . :WOr . . "oRTM TOWN OF NOR HANDOVER PERMI� OR PLUMBING ,SSACHOS� This certifies that . . . . . . . . . . . . . . . . . . has permission to perform . . . . . .a/,:� . !!.'e4' plumbing in the buildings of /��?Cl . . . . e./- . . . . . . _ . at.. . . .f (� . . . .fi?:�� . f"�hC(._. . . . . . ., North Andover�,,-//M/ass. Fee!,A),A) . . . .Lie. NoJ-.�1a C?. . . . . . . . . . PLUMBING INSPECTOR Check # 7745 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print r Type) as Date J&2(008 Permit# Building Location19,K) 141*11Owner's Name , VV Owner's Tel# �' ( Type of Occupency New Renovation Replacement Plan Submitted: Yes No l UZ z ? FF-- J N O z z W W W Y J (n U z O (7 N CLW to zLU to� H W x z a z O a aQ <nQrllNOCL 0 WO , WQW t �' �' Z a Y ww x 0 za OF- a ° x aa o z ° ° a z W � ° aQx o LL Y J m fn o o x r to W tY in o SUB-BSMT BASEMENT 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Addario s Plumbing& Heating LLC. Check one : Certificate Address 20 Cooper Street X Corporation 2720 Lynn, MA. 01905 Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J.Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch.142. Yes ❑x No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Ex 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 : Owner [Z] Agent Signature of Owner or Owner's Agent I hearby 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 compliance with all pertinent p isions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Title X Plumber City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) X Master Journeyman License Number 13106 BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FINAL INSPECTIONS SKETCHES FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE ,2008 PLUMBING INSPECTOR Date/ . N° 445 HORTp i .'4o TOWN OF NORTH ANDOVER H 9 PERMIT FOR PLUMBING ,TSACMUSE� This certifies that '. . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . plumbing in the buildings of . . . . . . . at ./ ?. . . - �!. '.� . . . . . . . . . . . . North Andover, Mass. Fee77!9. . . . . .Lic. No.�. j?. . . . . . . . . . . G/ PLUMBING PECTOR i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 1 • n • 14 O fil > t3N '� > C IZILI a s X z s r o o s $ w w w „ In .0 t ® - A r r r r r r r r a to Z p o o 0 0 0 0 0 :on c _ O s a a a a a a C 0X10 MATER CLOSETS $ J KITCHEN SINKS 0 LAVATORIES ` 2 BATHTUBS SHOWER STALLS _ DISHWASHERS c 1 DISPOSERS D � a $ LAUNDRY TRAYS O �• WASH. NAC". CONN. .� d () HOT WATER TANKS r A D TANKLESS O $ 9 IR SLOP SINKS Z m R e F FLOOR DRAINS H Q GASTRAPS r � 11 URINALS a a b m s3 DRINKING FOUNTAIN �Z -0 'f R � � AREA BRAIN WATER PIPING C c T O S ROOF DRAINS Q �s V 3' BACKFLOW PREY. W .W p OTHER FIXTURES: C to Ica: a m " z zg � 0 .� BELOW FOR OFFICE USE Opti FINAL INSPECTIONS �SKETCHKS, �E PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO 00 PLUMBING NAYS B TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED BATE 19 PLUMBING INSPECTOR I