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HomeMy WebLinkAboutMiscellaneous - 182 SOUTH BRADFORD STREET 4/30/2018I 9014 Date.. �. -. ( Z.-. k.1. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ,!Ut.�.4 i!�.. +.�� �! .............. has permission to perform .. �_.��c .,.-(,cac,.�rt" .t t?'+(f plumbing in the buildings of .................................. at ... I -C .Z..�s.�,, r In .� ,�.�.��-: �,. �tzc t, . , North Andover, Mass. Fee.30..(v..Lic.No..'%..y.r(J. .......lSs� .—Xd—.f------ Check # _LSI y- I- PLUMBING: PIPING — FIXTURES - FIXED APPLIANCES — APPURTENANCES Z FIJTIM TATAI ARAM OJT [AD CAflU eel rnrnu n I.— — — —......-.... ALTERNATIVE TECHNOLOGY I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING CITY/TOWN: ' NORTH ANDOVER APPLICATION DATE: 08/08/2011 ASPIRATOR JOB ADDRESS:! 182 SOUTH BRADFORD STREET PLANS SUBMITTED: YESF NOM pOCCUPANCYTYPE: COMMERCIAL RESIDENTIALQ EJECTOR Lj NEW ALTERATION[] REPLACEMENT FVJ REMOVAUDEMOLITION® I- PLUMBING: PIPING — FIXTURES - FIXED APPLIANCES — APPURTENANCES Z FIJTIM TATAI ARAM OJT [AD CAflU eel rnrnu n I.— — — —......-.... ALTERNATIVE TECHNOLOGY I DISPOSER SINK: MOPLJ SERVICELJ ASPIRATOR DRINKING FOUNTAIN STERILIZER DRAIN: AREA FLOORD EJECTOR Lj STORAGE TANK BACKWATER VALVE EMBALMING AUTOPSY URINAL BAPTISM: FONTF1 SACRARIUM FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK I GLASS WASHER WATER CLOSET BATHTUB WHIRLPOOLFT =1 ICE MAKER I WATER HEATER: ALL TYPES 1 BIDET INTERCEPTOR: ALL INTERIOR WATER PIPING: CROSS CONNECTION DEVICE KITCHEN SINK r OTHER NOT LISTED 1 DEDICATED: ACID WASTE SYSTEM LAUNDRY CONNECTION " RENTAL EWH DEDICATED: GASIOIUSAND SYSTEM LAVATORY ~ STATE ES680DORT #1126A019219 DEDICATED: GREASE SYSTEM PIPE RELINING WORK ONLY DEDICATED: RECLAIMED WATER ROOF DRAIN DENTAL FIXTURE / EQUIPMENT SINK: 1.2.3 BAYFJ PREP.FT I DISHWASHER SINK: CLINIC FIFLUSHRIMM PLUMBING INSTALLER — FIRM -COMPANY INFORMATION CHECK ONE ONLY NAME: WELCHBROTHERS CO., INC. `'- 148A TANNER STREET Corporation Business# 1501 C CITY: ' LOWELL - -s -- MA 01 - - - Partnership Business#� - _ STATE: ZIP: -._ TEL: � 97 .8 45-2100 .3 FAX: EMAIL: n LLC Business # U DBA /Unincorporated NAME OF LICENSED PLUMBER: INSURANCE COVERAGE I have a current liabilityinsurance policy or, Its substantial equivalent, which meets the requirements of MGL. Ch. 142 YES F7 NO If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy F71 Other type of indemnity 0 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. Signature CHECK ONE ONLY AGENT of Owner or Owner's AgentOWNER© . � OWNER'S NAME:,_TEL: ; FAX: I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. (OFFICE USE ONLY) TYPE OF LICENSE: Pennd# �]✓ Plumber Inspector✓Q Master Fee: M Journeyman Signature of Licensed Plumber License Number: 8481 W� F z° 0 U W d CE] W W O W n at Z LU 3 Q LU a W co ai w � W 3 w p o a w a as � a IL a co u; 2 W F- LL W O z 0 F U W a a cxh O a r! k Date ..... y.. `.... �. 0 .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that...............4- A .............. T ................................................................ has permission to perform .......... S / �✓d,/ wiring in the building of .............. f?.V cv..z . a .................................. at ....... tR ..... 5.....C✓C/1 ...... ,o h Andover, Mass. Fee... y.5...�—... c.. Lic. No..f�. ...........:�Iv E ECTRICAL INSPECTOR Check # ? Z 2, q 93►b (,ommonwa11, o/ MadsacL-ffePermit No. Official Use Only b)1� �eParfmarrf o�}ira �ervGca3 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfor-nad in accordance with the Massachusetts Electrical Code (NMC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE LL INFOr=O Date: -3 •� 9 J/ 0 N +� inspector f Ci or Town of: or To the o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) I d a_ s, 6MJ-1 _! -4yc� Owner'or Tenant S-'e'J�e 4- P<- ( Owner's Address f &-a ..S & z,,J9_d S Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps ! Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �I,vtnzz�U :4- N, d Yes ❑ No Telephone No. 17 If- 6k-6 --,000 0 / Fr Y! (Check Appropriate Boi) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters rt 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 SwimmingAbove In- Pool �rnd. ❑ nd. i n. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners _ FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges Na. of Air Cond. Total No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: ber I Tons _ KW No. of elf -Contained Detection/Alerting Devices _Num_ No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Cyonnection No. of Dryers Heating Appliances KW Securi No of Devic s� or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring• No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications lVinna, No. of Devices or E uiva�ent OTHER: / q7, �I-'/loCod Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �l 3 (When required by municipal policy.) Work to Start: u/1 //o 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 E]OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information. on this application is true and complete. FIRIM NAME,: u r't� S e r V i Ge.9 LIC. NO.:_1115C Licensee: cT." Signature LIC. NO.: /cc 9- - D (If applicable, enter "exempt" in the license number lin Bus. Tel. No.: tem Address: 1 l? . L-InTtsi'1 2 %l<o Alt. Tei. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department ofPubli'c Safety "S" License: Lic. No, OWNER'S IN E IVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. B i re below, I hereby waive this requirement. I am the (check one) ❑ owner ❑owner's agent. Owner/Agent . �,ci3- 5 S RMIT FEE: $ i/..�,� Signature Telephone No. - Department of P blic..Safety -� One'Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: Certificate of Clearance Number: SS CC 002577 Expires: 12/23/2011 WILLIAM M TAYLOR TR 18 CLINTON DR HOLLIS, NH 03049 -CAI G 35M.10/09.10162009L10ENSEFORMI D"t P;^.RTfviENT OF PUBLIC SAFETY Certificate of Clearance e Number: SS CC 002577 ' Expires: 12/23/2011 Tr. no: 1420.0 S -License: ADT SECURITY SERVICES WILLIAM M TAYLOR JR 1,9 CLINTON DRL - 03iOLLIS, NH 03049 Commissioner Restricted To: 00 Tr. no: 1420.0 Keep top for receipt and change of address notification. r, A ri {• O -0 n m O o � cn r •� � . in o z O• 'm n �rrf z 70 = x M m n1 i c z � v o q c I— . M c -t. r In �O0 _o D z W m 0 , _ 0 �, 7 N � w n !V p 77 C °' r z rn r Lr) Location So �', %J Y4 No. 30 ( Date a�; -U NaRTN TOWN OF NORTH ANDOVER _ o .: s a Certificate of Occupancy $ s,��UsE`� Building/Frame Permit Fee $ Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ © _ J Check # 'I 6U42 PIQ4 ' Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING DATE ISSUED: �� O BUILDING PERMIT NUMBER: 301 1 t (WO&NAMMUftwM00 SIGNATURE: om 0 Building Commissioner/122,wor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address:: 1.2 Assessors Map and Parcel Number: ,r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ -Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record r nn n Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Not Applicable ❑ Supervisor: C Licensed Congtruction Supervisor: License Number Address - ,21 Expirati Date re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number fj AK Address Expiratio to n re Telephone T M X Z O _ K a SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Constsucti 0 Existing BuilQig ❑ Repair(s) ❑ Accessory Bldg. ❑ Demolition ' ❑ Other ❑ Brief Description of Proposed Work Alteratio*s) ❑ Addition 0 a' I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building(a) 0 �- Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) C� C} 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name • Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DtIMENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Insurance. Co. Policy # /,'/5 � / / i /� --1C7-T r' 4 .4-12 C;P �✓ �� 4 Address City: Phone #: Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment_as_well_as_civil,penaltiesinihe.famd-a STOP W0RK_0RDER..and..afine.of_(.$1D0M)-arlay. against.me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under the pat,wand penald -orpet?uqry�Obt the information provided above is true and correct. Signature Date Ii S 2— Print name �. P_hone # Official use only do not write in this are to be completed by city or town official' City or Town Permit/Licensing O Building Dept ❑Check if immediate response is required Q Licensing Board p Selectman's Office Contact person: Phone A- ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector U) M) m Cl) 0 m CO)POP 'O CD� z CDCL O d r* d aC0 O p a� cr CD O .. . . CD v CO) CO O CO) n. 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This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** Q- Yt Y\4S"1' 6 vrn t r 6 APPLICANT: C' 1 r7 �1 o cU 5,t RL r Li o 11 Phone /�800^GC 61-/ GG3' LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street I_� A Sd ITh 6aw ford ST St. Number ************************Official Use Only************************ RECO DATIO OF TOWN AGENTS: DXDate Approved Conservation Administrator Date Rejected Comments Town Planner Comments Date Approved Date Rejected Date Approved lth Agen �61y ,Qo�� Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date mm o ro X0000 OA -Ina if "•t #f..�r �y� :i� I y mm o ro X0000 OA -Ina if I� K r cN c� m ip S r I O c fri c 1 I 0 r,� iA NOTE HEP: -70Y CEVI'71',`'-. 13 6 -',T ,S 3/-jok/N ;WT -,P!5 PLAN 4.RE NOT LOCATEV kIM'4)N T�•'E .tZ SCC: = = �:r\ y; , N- E -Lw NO. 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