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Miscellaneous - 122 OLYMPIC LANE 4/30/2018 (2)
122 OLYMPIC LANE 210/106.6-0122-0000.0 J BUMDIN ^ 122,: Olympl--- I � I I I I 1 I� i 1 I I Date,`4�7,07 41 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i o ��• ,Ss CMUS� I This certifies that . 6,44,1v c. �Jtf�i.Q`�.� t has permission to perform .A !�4 �./ . . . � . I/CjItve . . . . . , A. plum;,.'a in the buildings of .�.�. . .�f �.1. -. . at . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee.130,501-ic. No.I;33.,�D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # Peter P5 7427 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS e(o� ©� /'l�iC. Building Location �AJ ers Name /v Permit# 7 Amount Type of Occupancy ' New Renovation Replacement Plans Submitted Yes No FIXTURES rA CW w j F a w a 3 SSE q B4sRwm 1 LOM 4!H HDM 5M HL sM FUXR 7M ROM gmRfm Ft (Print or type) ' S, Check one: Certificate Installing Company Name y i T l" 1�0 ,9 7L P<v �,oiv-S 1:1 Corp. f �6 I ) Address � 3 � p��, Business Telephone 7 777777- 7753 Firm/Co. Name of Licensed Plumber. -Z-0-3cell >V Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityElBond Insurance 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 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 Massachusetts State PI b lodPIe and Cha ter 142 of the Gene ws. r BY: NIgnatUrC 01 UCe)5�Wer Type of Plumbing License Title �''� City/Town icense Number Master Journeyman APPROVED(OFFICE USE ONLY Cunningham Lindsey U.S.,Inc. ������ �G�,m. P.O.Box 703689 tv Dallas,TX 75370-3689 T 1����T, Telephone(888)738-8714 Facsimile(214)488-6766 L� /Y CLCAT@CL-NA.COM ***********************AUTO**3-DIGIT 018 779 T3 P1 95000058969 Building Commissioner or Inspector of Buildings 120 MAIN STREET N ANDOVER,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 805828 Policy Number: 805828 27 co Company Name: MERRIMACK MUTUAL FIRE INS 0) Cause of Loss: ICE DAM LO Date of Loss: 3/5/2015 o Insured: JOHN & DEBORAH HAROIAN j Property Location: 122 OLYMPIC LANE Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. I If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section'3'B:�No insurer shall pay any claims (1) covering the loss, damage, or destructions,tq,q building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section r six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located: If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. i Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 I i yard of Health Borth AndoveroMass. SEPTIC SYSTEM ` INSTALLATICK CHECK LIST LOT / MOM DATE DI AVATl +T OK F L �-- 1? . _2 easonst i+AIL j d 1. Distance To: a. Wetlands b. Drains 1 . - o. Well /' r i k/ r 2. Water Line Location �' �• • + . a , 3. No PVC Pipe 4. Septic Tank a. Tees - Length & To Clean Out Covers b. Cement Pipe to Tank- On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench / a. Dimensions ✓/ b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits a. Dim ms on$ b. SDept c. ash Pads Tees Xe. Cement Pipe to Pit - Both Sides f- Clean Double Washed Stone 8. No Garbage'Disposal 9• Final Brading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Perc Test d. Elevations e: Water Table Date`-�. NORTH TOWN OF NORTH ANDOVER '1 O�•,�•o y,4, PERMIT FOR PLUMBING SSACMUS� This certifies that . . . has permission to perform .•.-.� . ` . . . . . . . . . . . . . . . . . . . . . . . t plumbing in the buildings of . . . . .�-®.-.. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . i at. . . . . ..— ��. . . . . !. . . . . ., North Andover, Mass. Fee.$41 . . . .Lic. No.l B ;. . .. . . . . . . . . . . . . . GPLU BI G INSPECTOR Check # 8509 0- MASSACHUSETTS UNIFORM APPLICATION FOR.PERMIT TO DO PLUMBING Cit MA. 'Permit# 64 y/Towm—N Date-! Building Location.: i,. Owners Name: Type of Occupancy: Commercial Edu 'onall Industrial: ;i Institutional jr Residential -7 Alteration: Renovation:}New:F n:. Replacement:! Plans Submitted: Yes' No FIXTURES Tin 0 0 LU z 0) CO) _j 16- W in a U W W z � �,eg . w -j < MZD z w gu) wz wz � (J) 20i-L 3: U) LU VF U) �e U) .3 O 0 W Z z U. U) W 0 a W _3 001�_ I._ WgM _j < X1XWX �e 3: X z �e III III UJ W0 �_ X1L0WI-- Un < 0 OZ301-- I-- X W < < _1 < 0 < � 0 X _j � W < �_ _j _j W D 0 SUB BSMT. BASEMENT 15T FLOOR 2"')FLOOR T'TFLOOR 4H FLOOR 5 1H FLOOR 6'"FLOOR 7m-FLOOR -iTwFLOOR Check One Only Certificate# Installing Company Name: Kevin Scott Plumbing&Heating Inc. Corporation i2438 Address:'P.O Box 446 City/Town'Wilmington State: Partnership r7-t t Business Tel 978-988-3632 Fax: 978-694-9977 Firm/Company Name of Licensed Plumber: Kevin Scoff INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes,:, V -No If you have checked Yes please indicate the type of coverage by checking the appropriate box below. A liabilit insurance policy 710;;71 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. C.heck One Only Owner Agent Signature of Owner or Owner's 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 with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Type of License: Title! Plumber Signature of Li sed Plumber City/Town j _ . Master _ License Number: 13258 APPROVED(OFFICE USE ONLY Journeyman Date......... . .. . ........ ........ Of,NORTH A TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4L ,o .INS C This certifies that .............................. 7...................................... .............. ... ...... -��ecL,e has Permission to perform .......... -................. wiring in the building of............... .It,./.................................. at T ic.No... ...................................... ................................. ...North Andover,Mass. .VJ Fee.3�............ .......... ........... e........ ELECfRICALINSPECTOR Check # 9285 i D// ��//��jj Official Use Only Cf//�� w omrnweahk ol.//Iai9ackulethi Q Permit No. l Z FS _ ITa,_trn.;n.f o� ire�erviee6 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS I[Rev, l/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICA ELECTRICAL c All work to be performed in accordance with the Massachusetts. Code ) J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: �D� �4r�1�UF-,�— 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) iG L-.CJ Owner or Tenant -�Lf- ,gip Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building — Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electr=ical Work: �T:t� a �l c� /r� CI "cu�' y S�`� Completion ,f the table may be waived by the Inspector of Wires.. No.of Total No. of Rec,.; (Paddle)Luminaires No. of Ceil.-Susp.,_Paddle)Fans Transformers K!A No. of Lu.,:iirain'e Outlets No.of Hot Tubs Generators KVA Abuve ln- o:o ;,merger _y L tg h ting No. of Luminaires Swimming Poolorad. ❑ arnd. ❑ Batter;,Units ^ Burners FIRE ALARMS ,.No. of Zones No.of Oil Bu s No.of Receptacle Outlets N . No. of Detection and No. of Switches -- No. of Gas Burners l,�t;untina De�'ices Tct_:1 " No. of RLnges No.of Air Cond. No. of,,,,lerting Devices ' r To . H elf- untained No. of V•,'aste'lisposers k;eat P�:tm Nur ber ,:ons KW No. Se tAlertin Devices P _. ill De,^ction —•" "Municipal ' No. of Dishwash rs Spf: Heatipg KW Local ElConnection ❑ Other wHeatinAppliances . Security System^:* No.of Dryers KW No-.of Devices or Equivalent,— I� No.of Water KW No. of No.of Data Wiring: I Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No.of Devices or Equivalent I OTHER: 0 k= Attach additional detail if desired, or•as required by the Inspector of li"ires. Estimated Value of Electrical Work: 9f (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"coveraae'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 certif•,under the pains and penalties of perjury, that the information on this applicatinrn is true and complete. . FIRM NAME: '..JF_Liz / �C—/�j/ LIC. NO.: h` Licensee: Zk-17y ire /erc Signatur LIQ. N0.:�021}.D (If applicable, enter "exempt"in the license number line.) Bus.Tel.,No-.-: -3 Address: LJ d� J�/S O�Q AIi,1 Tel-'No — .*Per icense: Lic.No. cab CGt 0UO S/ P et "S" L rtquires , lent of Public.oaf _ M.G.L. c. 14 , s. ��-61,security���orl. q s Departn Y OWN'ER'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. 1 am the(check one) ❑owner ❑owner's agen Owner/Agent PERMIT FEE: S Signature Telephone No. 1 COMMONWEALTH OF h1ASSACHUSETTS OF ELECTRICIANS - REGISTERED SYSTEM TECHNICI N - ISSUES THIS LICENSE TO ARTHUR W PIERCE p, • 'is � � � 1 U P H A M `=T ro G SALEM MA X1970.-2516 a �' 1-0 '_4 D 07/31/10- 3Z0257• 5= Certificate of Clearance .' N'umber: :SS CC OD0517 Expires:`08130mi0 Tr. no: 152.0 - S-License: AAT SECURITY SERVICES ARTHUR W PIERCE 18 CLINTON DR HOLLIS, NH 03049 ✓�� �� DIG SAFE CALL CENTER: (888) 344-7233 Commissioner J �:is 9990 Date ...2,'.'Z.'............ NORTIi TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS This certifies that ►O.Y1...... ... ..... ........ ... . .... ...... has permission to perform ..................................... ...... ... ... wiring in the building of... .......................... at..... ..4`J.`............... ........ ..................... North Andoyei,Mass. Fee..�................ Lic. Check # d-4 . -Commonwealth of Massachusetts Official Use Only Department of Fire Services [fRev- 1/0710_ ermit N . BOARD OF FIRE PREVENTION REGULATIONSccupancy and Fee Checked leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricaL1nsp_ect�or_qf (MEC),527 C 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: -j2,Z ! City or Town of. NORTH ANDOVER To the res: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) S Oa4m, Le Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building - Utility Authorization No. Existing Service200 Amps 124 /Z� olts Overhead ❑ Und g No.of Meters New Service Amps / _Volts Overhead ❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- o.o mergency ig ting . rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and InitiaYin Devices No.of Ranges No.of Air Cond. TotaV--- No.No.of Alerting Devices No.of Waste Disposers Heat Pump Number .Tons KW No.of Self-Contained Totals: Detection/Alertino,Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* fl No.of Water KW No.of No.of No.of Devices or E uivalent Heaters Data Wiring: ` Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: , No.of Devices or E uivalent Estimated Value of Electrical Work: �y�, 4P. Attach additional detail if desired or as required by the Inspector of Wires. G (When required by municipal policy.) Work to Start:-_ LL / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO E GE: 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,tinder the pains��nd penalties of perju ,that the information on this application is true and complete. FIRM NAME: jj(G}' -/u E,02 N� aR N-ur LIC.NO.: -3 !S SCG E_ Licensee: �'(� Signature LIC.NO.: (Ifapplicable, enter "exempt"in the li�a number 1' e. Address: �.{ �� �( Pia. a t �� _/ Bus.Tel.No.: �8= ,�-S 3[! *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lic.No. 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 Signature Telephone No. PERMIT FEE. $ ELECTRICAL PEp"T NO. INSPECTIONREPORT: ELECTRICAL INSPECTOR-D OUG SMALL =edF,,gjled : Failed— nregwired($50.00)-j j 'Signature-no initials) s ' Date 2.FINAL INSPECTION: Passed— Failed—Dq3-23- ! Re-inspection required($50.00) Inspectors,comments: �C (Inspectors'Signature-no initials) Date 3•UNDERGROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00) inspectors'comments: (Inspectors}Signature-no initials) Date 4.INSPECTION—SERVICE: - DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ j Re-inspection required($50.00)-j ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ j Failed— Re-inspection required($50.00) haspectors' comments: 'Signature-no initials) Date )DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SHE IF THE AREA TO BE INSPECTED ISNOT 7[` ACCESSIBLE AND ARE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name.(Business/Organization/Individual): Address: City/State/Zip: eal 4 Phone#: 6 Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. El am a general contractor and I loyees(full and/or part-time).* have hired the sub-contractors 6. El New construction I am a sole proprietor or partner- listed on the attached shget. 1 7• ❑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. ❑ We are a corporation and its e required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I 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 required.]t employees. [No workers' comp.insurance required.] 13.0 Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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: Policy#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 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 ce fy under the pa' a d penalties of perjury that the information provided above is true and correct. Signature: Date: 3 — L�. Phone#: 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#: 1y 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-contractor(s)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 Investigatitons 600 Washington Street Boston}MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia E � 'AOT ha TOWN OF NORTH(ANDOVER PERMIT FOR PLUMBING V s •'a ,SSACMUS� ` This certifies that . . . . . .c . . . .h. . . .. .`. .° . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . .U— f. . . . . . . . . . . . . . . . . . . . . . . . Pg g � /� ° plumbing in the buildings . . . . . . . . .f:�. . . . . . . . . . . . S` b ( , F' at. . . . . . . . . . . . . . . . . . I North Andover, Mass Fee. ? U.r- . . .Lic. No— A)/� . . . . . . 4 . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # Y 7472 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) � -,5 ND �`iG',110ass. Date 0 2007 Permit# { I� �. Building Location Moe ff LN • Owner's Name ( C [ Owner's Tel# ��"g"' ZJ�g—'�3� Type of Occupency New 1:1 Renovation Replacement Plan Submitted: Yes No z z Cl) o Z w cn W Y J 0 U Z D O fn w to Z (Al H W = O �Z� OZ—. z H CL OZ a m N 0 Lu Fw-i � z a o- ,C) a O X w W W Q N Q J fn W � J Z 0 lX 0 u- lX H C=i Q 2 'S = a z 1 a O Z Z Q lw LL 1 w a a s °x T S2 a a 0 a ° ° a W W W a °O a ►- Y J m N O t] J 2 H N LL 0 M o Q w m 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. 1 Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage - I - jI have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch.142. LXJ If you have checked yes, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws,and that my signature on this permit application waives this requirement. Check One : Owner El 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 ' be in co Hance with a rtinent provisions 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 :S I' v r I F BELOW FOR OFFICE USE ONLY � I FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO DO PLUMBING i a 5 NA 'E &TYPE OF BUILDING nrt i a LOCATION OF BUILDING P U1'ABER PERMIT GRANTED ' DATE ,2007 PLUMBING INSPECTOR r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (p 2 (Print or Type) Mass. Dated _/ 19_1'J� ,. a City, Town Permit # 2. 3 Z y Building — Owner's - AT: Location L � �ti/4 .,.. Name z2 go 6 '9Z 5`7 Y Type of Occupancy: lif New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No N W N . Y 2pC N to J N O 0 p=p Cc Q m N acc O O O Z FW- ' x W Q W W N a x Q W W W N J Z Q Y 17 cc W x W O W V N v C9 F- Z J H Z t✓ W W O > WH W J I- W Z Q W Q it H r N 0 Z O Z O N x Q W > LY W O .Q a O O W O W, oc x o o x W 3 o ty J U ac > o a o SUB—BSMT. BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR (Print or Type) Check One: Certificate Installing Company Name Gagnon Plumbing Heating; & Gas Inc. �] Corp. 1524- Address P.O. Pox 8860 ❑ Partnership Salem, 1•1A 01970 ❑ Firm/Company Business Telephone 508-744-4.14.9 Name of Licensed Plumber or Gasfitter .TbDma.s R. Gagnon 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 Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. Signature of Owner/Agent I have a current liability insurance policy to include completed operations coverage. 17/4 Gz� By TYPE LICENSE: OCT 1 611� Signature of Licen Title ❑ Plumber Plumber or Gasfitter City/Town ❑ Gasfitter APPROVED (OFFICE USE ONLY) ® Master 10136 ❑ Journeyman License Number FORM 1243 HOBBS&WARREN,INC.1989 'COMMONWEALTH OF MASSACHUSETTS 10 y • f ',, ..BOARD ! IN PLUMBERS AND GASFITTERS IMPORTANT NOTICE h PL I LICENSED AS S JQURt�EYMAN PLUMBER PERMITS FOR PLUMBING AND GAS FITTING ISSUE THISS LICCttNNSEE �T�d INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE r THOMAS R .;GAGNON m OFFICE OF THE STATE BOARD, TYPE. I € I -J ro PO BOX 8860 y SALEM MA 01971-8860 ! €„154984 I 18597 05/01/98 154984 4 COMMONWEALTH OF MASSACHUSETTS` 3: a nth S �� €y r .+`7�ry:sy I ;n V' '�a Fr; roti- A�r;e< y h'�t�.•r'S'cd� �'�,�,p.�r^ �'a�” €.>BOAR:D ~'I IN PLUMBERS AND GASFITTERS IMPORTANTNOTICE` Y PL LICENSED AS A MASTER PLUMBER PERMITS FOR PLUMBING AND 0AS FITTING H 1 ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FACILITIES MUST BE FILED AT THE, ; s ' TYPE;` 1 `. THOMAS R :GAGNON m OFFICE OF THE STATE BOARD t I k Itl -M i. PO BOX 8860 `a I I. SALEM MA: 01971-8860 { 154985 ! 10136 05/01/98 154985 COMMONWEALTH OF MASSACHUSETTS IMPORTANT NOTICE BOARD I IN PLUMBERS AND GASFITTERS } w PL I REGISTERED AS A PLUMBING CORP HERMITS FOR PLUMBING AND GAS FITTING • I ISSUES THIS LICENSE TO INSTALLATIONS ON STATE OWNED OR USED FAC0TIES MUST BE AT I OFFICE OF HE STATEILED BOARD.. ', '. TYPE i THOMAS R GAGNON • m —C. PO BOX 8860 SALEM MA 01971-8860 154986 ; 1524 05/01/98 154986 •� ✓fze 'C007.vrreapwre2�,/� o�✓!/(,nteac�uded T..—— r Restricted To: 00 13428 DEPARTMENT OF PUBLIC SAFETY SPRINKLER CONTRACTOR LICENSE s Nuiber `. . Expires Birthdate SC ',002265 08/31/1991 08/31/1951 Restricted To` 00 6 z nr,T .THOMAS R GAGNON d DRUMLIN RD � IPSWICH, MA 01938 GAGNON PLUMBING HEATING&GAS FITTING,INC. 1328 Town of North Andover 10/15/96 6500•Licenses and Permits 15.Q0 Checking 122 Olympic Lane Haroian 15.00 f � TO 2324 Date. .C"....... of ,,ORT'. TOWN OF NORTH ANDOVER �? PERMIT FOR GAS INSTALLATION: 5Ui �9SSACHUSE�ty �.�This certifies that : . 6-4?.h-.q h. . . . . ;. . . . . . . . . . . . . "' has permission for gas installation . . 41? .0%! . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ! .. . . . . . . . . . . . . . . . North Andover, Mass. Fee f Lic. No. ! . . . . . . . : . 4SINSPECTOFF WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File