HomeMy WebLinkAboutMiscellaneous - 19 ALCOTT WAY 4/30/2018 19 ALCOTT WAY
- 2101025.0-0016-0019-D
N° 94669 `Bate.
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
ri"040.
•D�•TID
_ ,SSAGMUS�
'Z 1 �4 C.t fiz-r
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . ' Yt`'^'
at. . . +. . . '(. .t`''r.U-47 . . . . . . . , Nort Andover, Mass.
Fee.3Q9,?. .Lic. No.. .�i. 3
PLUMBING INSPEC
Check # &76 7 "12co
t:
WHITE: Applicant CANARY: Building Dept, PINK:Treasurer
. `&L MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITYMA DATE PERMIT#
JOBSITE ADDRESS ¢ OWNER'S NAME —
POWNER ADDRESS Tlf FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[ PLANS SUBMITTED: YES❑ NO[]
FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY r�
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES t!
WATER PIPING
OTHER
I
INSURANCE COVERAGE:
I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[2 N0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
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.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application true and accur to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be n lance ith I erlinent provisio f the
Massachusetts State PI ing Code and Cha ter 142 of the General Laws.
11 y
PLUMBER'S NAME LICENSE# Q1QNATURE
MP(" JP❑ CORPORATION #PARTNERSHIP❑#=LLC❑#�
COMPANY NAM i ADDRESS
CITY
�� Lj`yy� STATE� ZIP d TEL
FAX CELL EMAI01111,11 lo ''I
Q OIC
�% AZ`s
Uyw�
� " " '
��
COMMONWEALTH OF MASSACHUSETTS:.
PLUMBERS AND GASFITTERS
LICENSED AS A MASTER PLUMB-R
ISSUES'TiE AD(aVc LICENSE 7
ROBERT A SAMMATARO
8 DUNRAVEN RD
WINDHAM NH 03087-1263
9333 05/01114 . 170
COMMONWEALTH OF MASSACHUSETTS�'W
4
REGISTERED AS A PLUMBING CORP +
ISSUES NE ABOVE UGENSE TO.
i
ROBERT A SAMMATARO
4 ROBERT A SAMMATARO P&H, INC
8 DUNRAVEN RD
I WINDHAM NH 03087-1263
3373 05101/14 140820
i
i
1
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NORTH
OFtt`en '6,910
3� 46 OL
0 4
�9SSACHU`����
BUILDING DEPARTMENT
(ommunity Development Division
October 18,2012
Dear Mr.Sammataro,
We have received two permits from you one for 17 and 19 Alcott Way and one for 116 Bridges
Lane and 92 Moody Street both of which are located in North Andover, MA.
Both permits are missing crit' I information and cannot be issued until the permits are
co�tete. We need a copy of your lumbing license(s)as well as a copy of your Workman's Comp and
iXability Binder so that we have proof of current insurance. Both items can be faxed to the office at 978-
688-9542 or mailed to 1600 Osgood Street, Building 20,Suite�o-qs_ni„rth_Andnva_r:._MA_01845.
The permit application for 116 Bridges Lane and 9211`
A message was left for you on 7/22/2011 and a follow up mel
to receive a check for a total of$65.00,$32.50 for each per L—U V l�Gl jam"
of a dishwasher at each location. I Pafwu�
The permit application for 17 and 19 Alcott Way,a cl
amount of$50.00,the amount needed is$60.00, 30.00 eacl �I zo i 1 Np e (r3-�
installation of a water heater at each location. NutIL `� P
Thank you for your attention in this matter,if you hZI, IVA—L w
978-688-9545. bjus- CzS
Sincerely,
Mau a Deems
Building Department Assistant
12
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 9.18.688.9545 Fox 918.688.9542 Web www.townofnorthandover.com
1
NORTy
��A.,Lao /6 A�O
� A
"19 �"ATED
SSHCHUSFt
BUILDING DEPARTMENT
fommunity Development Division
October 18,2012
Dear Mr.Sammataro,
We have received two permits from you one for 17 and 19 Alcott Way and one for 116 Bridges
Lane and 92 Moody Street both of which are located in North Andover, MA.
Both permits are missing crit' I information and cannot be issued until the permits are
coopplete.We need a copy of your lumbing license(s)as well as a copy of your Workman's Comp and
ivC ability Binder so that we have proof of current insurance. Both items can be faxed to the office at 978-
688-9542 or mailed to 1600 Osgood Street, Building 20,Suite 2035,North Andover, MA 01845.
The permit application for 116 Bridges Lane and 92 Moody Street was mailed in without a check.
A message was left for you on 7/22/2011 and a follow up message was left on 10/20/2011,we have yet
to receive a check for a total of$65.00,$32.50 for each permit applications pertaining to the installation
of a dishwasher at each location.
The permit application for 17 and 19 Alcott Way,a check was received on 10/10/2012 in the
amount of$50.00,the amount needed is$60.00?,(�3�0.00 each for both permits pertaining to the
installation of a water heater at each location. (�1^yc L 40 �t IwA.
Thank you for your attention in this matter,if you have any questions please call the office at
978-688-9545.
Sincerely,
Mau a Deems
Building Department Assistant
1612
ek-17 ilk
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9545 Fox 918.688.9542 Web www.townofnorthandover.com
Date......1."..
i
NORTH
°f<�``° '•�"o TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
�'ss��►+U5�`�
This certifies that .........................�ke. . 1.2A/.....................................
Chas permission to perform ... �� .t�7'- ? �......................
. . ...........
E
....................
wiring in the building of....................... ....................................
L coT !.(//��/ North Andover,Mass.
Fee...: ". Lic.No.-.).D3�........ ;���'-`'"i ,Ls/ ..... ........
ELECfRICALINSPE •R .
r
Check #
r 7655
-N Commonwealth of Massachusetts Official Use Only
Department of Fire Services permit No. 76 C-
BOARD OF FIRE PREVENTION REGULATIONS [ eOccupancy and Fee Checked
r' (leave blank)
' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9✓-W� 7
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned Ives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) LGo7 (/
Owner or Tenant )4i't p✓7 Telephone No.
Owner's Address 6,110,
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 100 Amps ltd / 'Movolts Overhead ❑ Undgrd® No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 4 t — D7 �Q re a-F e
Completion of the following table maybe 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
AboveIn- o.o Emergency Lighting
No.of Luminaires Swimming Pool rnd. Lirnd. ❑ 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 No.of Air Cond. Total No.of Alerting Devices
Tons g
No.of Waste Disposers Heat Pump umber I Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters 'Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications ging:
No.of Devices or Equivalent
OTHER: — 60 '" 7eC7or
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 2 (When required by municipal policy.)
Work to Start: Irl 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 E4, BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: /d/ 1 LIC.
Licensee: beo^,� �jtr((J�<^ fjr_ Signature LIC. NO.:
(If applicable,enter "exempt"in the license n:ber line Bus.Tel. No.:
Address: �U3 �,✓<<51r/tp /�� �� �n , P/`5 N
Y Alt.Tel. No.:
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S" License: Lic.No.
OWNER'S INSURANCE WAIVER: 1 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. $
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 Legibly
Name (Business/Organization/Individual): 1.eon't / 57c
Address: o
City/State/Zip: Ae74L)en , Al� 4015 y Phone #: 9 7q —
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.g I am a sole proprietor or partner- listed on the attached sheet.$ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in an capacity. workers' comp. insurance.
Y9. ❑ Building addition
[No workers' comp.insurance S. ❑ We are a corporation and its
required.] officers have exercised their 10.®"Electrical repairs or additions
3.❑ 1 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'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing thew workers'compensation policy information.
t 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:
)ob 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 cerltfv under the ;anpenalties of perjury that the information provideed above is true and correct
Sianature: �� Date: 7
Phone#: ��1 ��S ^7,1C
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermitlLicense#
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#:
I
Date.�l,. ....... ...
�.
NORTH �
4,
3? �` TOWN OF NORTH-ANDOVER
• PERMIT FOR GAS INSTALLATION
. 9
"a y9SSACMUSEtt
This certifies that . . (rG u v G/6t. . . . . . .N-7. . . . . . . . . . . . . . . .
has permission for gas installation . . rf A At . . . . . . . . . . . .
in the buildings of . a. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at /`--1. .,- ?/t-lc. .177f. . . . . . . . . . . . . . ., North
Andover, Mass.
Fee;,2. -. . Lic. No../4Q?
GA5 INSPECTOR
Check#
6'237
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
Mrint or Type) r
AVO A idoye r ,Mass. Date 1° 20 ` Permit# L- 2
Building Location CQ f � Owner's Name EaL4 r' (2 hQ k
6-&f,& u'-°' Type of Occupancy
New ❑ Renovation ❑ Replacement LAY Plans Submitted Yes ❑ No Cl
m
Y W �
rA U) U Ir kms- �
W co � W O 0 m H u3
in
O W Q o: o: Z D O Z W
ra W (— W W O kL X W Q
!n u�1� fA C7 U W x co W Q CC
Q '! W (n
0 F- Z _j_ !- Z 1. W W 0 > LL F U }N.
Q W > 0 W j Z Q E Q c wctt O V W � O H
0= S O 0 I lL Z 3' Q 0 J U lL > O b F O
1 1
SUB.BSMT.
BASEMENT
k 1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
8TH FLOOR
TTH FLOOR
8TH FLOOR
Installing Company Mine rrpm ic, i�to.'e . ?La6, ursrT_i 3t' - Check on . Certificate
Address t 0f`� 1`�r11 C',P to 464 �- C tion �
d
h*n,,r-,u(j ❑ Partnership
Business Telephone " A £900 ❑ Firm/Co.
Name of Licensed Phimber or Gas Fitter Fi-an )(.- GVUVC'1 —
INSURANCE CO GE:
I have a cu iability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142.
Yes P No❑
if you have checked yes,please indicate the type of coverage by checking the appropriate box.
A liabilityinsurance of indemnity ❑ Bond ❑
Pd� tYPe dy
OWNED MSU RANCE WAIVER: 1 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❑ Agent O
nature of Owner or Ownses Anorit
I hereby cer ty Stat all of the details and information I have submitted(or entered)in above application true and accurate to
the best of my knowledgis and that afl plumbing work and installations p�f under the permit' for this application will
be in compliance pertinent provisions of the Massachu!! PI bang Cade and Ch er of the General Laws.
BY l�P so
-01f� U
Tille
❑Glum Sig re Of Licensed P tmtber or Fitter
C!ja0wn D Journeyman License Number � ���-r3 ?
r1F�M`F 1 nw n m,n
Date. ! . . .. . . . ..... .
5
o? TOWN OF NORTH ANDOVER
0 P
PERMIT FOR GAS INSTALLATION'
♦ 9 ♦
SACHUS
This certifies that . . .,- �. .(:v. . �. . . . . . . . . . . . . . . . . . .
has permission for gas installation . . .tI,
.
in the buildings of . 5.4. . . . . . . . . . . . . . . . . . . . . . . .
at . . . F?. .114.<.<<: . North Andover, Mass.
Fee. ).q.�. .. Lic. No..�
LNSPECTOR
Check# /f
6121
MASSACHUSETTS UNIFORM APP11CATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date - L
7
NORTH ANDOVER,fMASSACHUSETTS
Building Locations12-1
Permit#
AA ,,
�V n, W D.��P/11. Owner's Name Amount$
_LU
_,J,.,�
New Renovation Replacement ® Plans Submitted
W a
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W d x Z Z F w
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a w a zG W o v, a a W d
WF
Z a > `� W a a' W' rA ° zz o z W o x
z o m �' 7 3 a U a >
SU B-BASEM ENT
B A S E M ENT
IST. FLOOR
2ND. FLOOR 4TE
3RD . FLOOR
i 4TH . FLOOR
5TH . FLOGR
6TH . FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) - Che k one: Certificate Installing Company
Name , Y`
Corp.
Addre Partner.
usmess Telephone !ViL _ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No�
If you have checked es ple a indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity 13 Bond 13
Owner's Insurance Waiver:f Imam 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 13 Agent 0
t 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 Sta as Code a ter 142 of the General Laws.
By; Signature of Licensed Plumber Or Gas Fitter
Title � Plumber
City/Town Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) Joumeyman