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HomeMy WebLinkAboutMiscellaneous - 19 ALCOTT WAY 4/30/2018 19 ALCOTT WAY - 2101025.0-0016-0019-D N° 94669 `Bate. 'i 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 �I 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 U z 1-4 rA U � W d x Z Z F w o � z 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