HomeMy WebLinkAboutMiscellaneous - 2 WALKER ROAD 4/30/2018927$
Date..//44...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
JSACMUSE' � � / , /
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This certifies that ......... GCS /-....... ...........
has permission to perform �f�_��/�t .. ... .
plumbing in the buildings f .?"!�% ���?S�' ....... .
at ... Z .� �f.�.?# W ........ , North Andover, Mass.
Fee �' ,.aU . Lie. No.. O 'oa ......
PLUMBING I PECTOR
Check # —�
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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TYPE OR
PRINT
CLEARLY
CITY N n Ivvo VMA DATE , I ` l,� PERMIT s
JOBSITE ADDRESS WQLJ Cf Q I I OWNERS NAMEI
OWNER ADDRESS TELT IFAX I
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
NEW. ( ( RENOVATION: (V( REPLACEMENT: ( ( PLANS SUBMITTED: YES ( NON/(
FIXTURES Z FLOOR-
BSM
1
2
3
4
5
6
7
li
9
t0
tt
12
13
14
BATHTUB
d
'
Y
CROSS CONNECTION DEVICE
4
!
1
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM
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j
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
I
--
FOOD DISPOSER
i
FLOOR /AREA DRAIN
!
--
i
j
INTERCEPTOR INTERIOR
✓ _
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
---
1
-
-`
--
-
-- -
WATER HEATER ALL TYPES
--
-
_-
WATER PIPING
OTHER I
-
INSURANCE COVERAGE: - -
I have a current liab_ ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YESYJ NO (
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ( ( BOND (, F
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.
- CHECK ONE ONLY: OWNER ( AGENT
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submilled or entered regarding this application are true and accurate to the best of my knowledge
and that all ptumbing work and Installations performed under the permit issued for this application will be I liar V' 11 rtinenl provision of the
Massachusetts Stale Plumbing Code and Chapter 142 of Ume General Lags.
PLUMBER'S NAME � d WQ lCh I LICENSE 111.30900SIGNATURE
MPI I JPlyf CORPORATION) Ill! 1PARTNERSHIP1 1M LLC( Il{)
COMPANY NAME I Sj'1vWj' R,0 Y�',/ Motel ADDRESS �X MC (Y , t'rlpm C ��_-
CITY I `40,V C -f � � JJ f" I STTATE I �"�' � ZIP 1 0 Q � TEL � � C�C� 3O.3 +030 1
FAX I I CELL I -j$1 57o6- MAIL I w e ka-> j ko 1 iJ (�9irnq 1 coin 1
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listed 611 fhefluachettS1teel.'t
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Rite up Eo'$1,OQ ()0andfgi Dile year itnpr sontnenl,. as %veft as civil PCIIAllic-S In ilie forut of it STOP=\PORK ORi rR 6n( tt titiC
tifap (05250.00 a, clay+. tgailtst Me- t iolator. 13o adt�iscci That itcopq oFRtlis SEalEniciiEitta}° frefont%arileJ to Elte Olfice of
lu estigalions.orliteD1R('oriostimtrcecoveragetcritGcation.
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is�tiiligtiiitFiort[;4 (citzTeoitc):
i. 0011II COrHcatth 2. Building DeJ>.neliuent 3. City'ffmit dcd( �. LisctrlcnlTnspea`[vi' �:1'ItitttUfltg lnsj}e�(ot`
G. QtticIr
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T assrteliust tts,General i this vbapter 152 recyttiies all employerstoa,Yav de:�vor�cers' o)jIpP1i4wt0# foFtiteicempTn}ees:,
US aneii�j'oy�e..i�rTeliiiea as< :-,eiteiypersoit$rfltese"-, ceofait.othcrtinit�roti�rcontracto) lii>e,.
e .P* orkiiplied, oralorn7itlen `
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o€11[gforegoingeitgsgectni a loinPenferpriseg aiiclfa$liidingthe Ieg'al ii prescnCat:t=�s bfa decease emptoj�er, ort he
receic=$Or't1TFStCeUfaitrxiVldloal,�)aitlleFSlllassociation:oroilteriegaTentit} ct>t�iid}�ingen�plo}rees Fioivetiertho
oW1W ora clic+elliiig-house.haviftg,afJubfeilian three;apafftlieiits:aud'ivho wsides tiierein, or the occupant of One
c*afiiog hotisuot=another-who emplo}rspetsons to do•niaintenaiice, consinietion of ie air'ivorl: on sttcli dtt�iliag lioitst�
ibrou:titbgratntds.ox buildi11900urlenatlttliereto,Aballijiol beeattte•.of sueli.einplo}'trent be cleeme(Vo be au �nipidyery'=
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that'"e3 of t(st'afc ot~ Isocal ticenshig tigeiic}� siittlf i4itlMOUT tWAAtiauce or
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np licant�v Jiastiotprptluceclnccepfnblee fcieticeolcaniplittnce�tilfh_theuce.coxerogerequirea?,
Adtiitibiiait}; kiGi:eit tpteci52, 25C(7) states "j`Ieither the couiniomvealthnoraa}' ofits politicalsubdivision!� shall
e#ltOr into any contract'for the parfornlatico of publ is ivorktuitil acceptab?eevidence ofcouipliancetviili the insttrance
re.�iiuemenis oFihis clispterIiavc been preseaiteci to the contracting authorit};"
i?feaseftlCout tTIYliar�:ers'olnliensaCouflifiilatitti6nipIfoty,p�+.Ttecivitgtiiefiosesihatapplyf4y0tirsiittatiotitttl,if
:»ecessatj; suppl}° silo-contractor{s) iietue(s), addiess(es)'Andphoneninhli�t-(s) aloi�;�vith thea cec�iiici;le�s� pf
insitra►im. i.imitedtiabilify Coinpatiies (LLQ orLimitedI.iabifitjtPattiioiships W)Will,no eutploy+ePsotlier'tliair:t►ie
itetiibers orparhiers, arenot requiredto catty lvorkere cogipt nsatio I insurance. Ifan' LLC or LLP floes Haire
'Inploy=ees,apolic,Yis►uquired._A�ftdvised`iliatfhis-ifficlae,tinay6esiibntiuecitothe-Dep;uinieiitofIndustrial -
Accidenfs:forcoitlirtnatioitofinsntaticeooverage. Aisabesttretosignntiddatetht nffidavif. ?li0cftidavitshotild
tie returned to tlta city or town that 1110 application for the permit or license is bem_requestcd, not titeDeparinicut of
Ind(tsli'ial Accidents. Stro([t(1 yoit littvz airy fiuesiigns r, garditrgdhe lain di ifyo'ti are rcgttirecl to obtaiiia tirotkcrs'
Eoitipeli0tionpoticy, please call the'D;ji�ttinetti:TAE[tentniiber;fistedbeloiu. elFins(uecl.coltipatViessltonitl"ter their
self uisuturree license numberosL11110 Qpropriafe line.
City of To
}in Officials
I'lettsc btl; sure flatiie affiitavit is cotu ilete bttrtl�riulcttleg'ihiy. 7liebepaitiiientLtas provided tz > Paco at the bolt(int
,of(he,nfticTavit £of yoittd fill itt'infheeveuflboOfrimoflnvestigationshas to coi ddyour4!rdvigtheapplicant.
PieasebeisuratofillinthepennitlljcensamumberMitcttoill.beusedasa:referenceailimber. Ina&ihion nnapplicant
ii taf must sub»iit nuilfiple perniiflticeiise applications in anysgiveit year, neecl'only sttliniit one 4-fdavit indicating ctin ent
Voticyinfomiation(if ncccwary�widutidei"JobSite:AddreW, the. applicatit'shouldwrite"alIlocalionsin . . (cit}nor
%6 Vn}.`A copy ofllie affidavit iliathas beer) of6ciallystamped ormarkdcl by the city or tone, nray beprovided to Elie
iiliplicant as proof that -a vafid Tiftidavitii ori ifileforlidtire-peroiits of licenses. A ifeiv titl'idavit inust 6e filled out each
yaar. Zj7terea ltonie owner or citizen is oUtaii{rhg.a license orperniit not related to ankbnsi,iess orconnnercial t=entute.
(i e. a dog license or peeniit to btim l'mves elo) said person is NOT required to colnple€etlds tiffidmit.
't'lie QiT`iCe of Iiiiietigafions tit+oi:Yti like [ri'tliitt� �+ort in ailvarrce foe yo(u co�ii�r'titiot iijid s>ioljd �=ott.ltat'� aiiy gtiestiorts,
pl�a§Ddo.not liesifaie to givens Aogll'
Tile Deparh,is nt'sactdr�ss, telepltaimand fax mu►ilbee
The C`.omlliomuw1_;tlt Of Mit*oltctie.-m
D3e1iachttent of Jgdustc'M14C1Df1d011ts
Office of•111ya lgAI(ow
600AVashitlgtoll Streot
Boston, MA. 02111
Tel. t# 617-727--000 Oxt.406 o,' 1-877 MA8sApb
itekiseil 26-05 A19'16I140.7749
WIVI Ahass gov/dia
Date. .
NORTH TOWN OF NORTH ANDOVER
0-
3: - • OAC
I -p PERMIT FOR PLUMBING
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This certifies that .....�.... l.!.... ... .... .... .
has permission to perform r. /f.L- ...r....(.
l ///n
plumbing in the buildings of .... /.d !f'!(: (.'O. `` ................ .
at. r ..1.`P!i...��...../.!�.0 .... �... , North dower ass.
.
F140'f- .-P Lic. No...
Check # l R)
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PLUMBING INSPECTOR
I
8
MASSACHUSETTS U NORM APPLICATION FOR PERMYT TO 1) O PLUMBING
(T)rpe or print)
NORTH ANDOVER, MASSACHUSETTS
G���
Date_7�
•
Building Locatio ,Q�(
Owners Name �l / v
Permit #
Amount
_
Typbofoccupancy
New 0 Renovation 0
Re Placement Plans Submitted Yes
!..- d No
Check one: Certificate
(Print•ortype) /`f Corp.'7T
Installing CompanyName 4
Address
Name ofLicensed Plumber: �/ ?-W
Insurance Coverage: Indicate the type of insurance coverage by checking�appropnaie box: Bond
Liability insurance policy � Other Type of indemnity
;Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one ofthe above
three insurance
Signature
%I Owner Agent El
-
Ihereby certify that all of the details and information I have submitted (or enfered) in above application are.trae and accurate to the
best of mylmowledge and that all plumbing work and ins_ ations performed under Permit Issueii for this application will be in
compliance with all pertinent provisions of the Masses in Code and Chapter 142 of the Gen Laws.
Title
City/Town
APPROVED (OFFiCa USE ONLY
rgna 0.1i,icenseWiumba
Type of PlumbiigLicense
kens �� . Master Journeyman
Date. �X//
U ...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
y ?/c S r e -
This certifies that .. ,��!%l.... ............................. .
has permission to perform .... �' .. . G f f ..� ��. �`......... .
plumbing in the buildings of Jr P........................
at. ........ • .. • • , North Andover, Mass.
Fee. 3P4'..Lic. No.. 5..�.� .�•. `.. ..-+.........
PLUMBING IN PECTOR
Check * C S
8347
_
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
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City/Town: `/�/�-M7q, Date: Permit#
Building Location: D� �/`��'�`2 �� ° (/�%/� Owners Name:
V
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ Na ❑
FIYTI IRFR .1
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes,LXj No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check 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 lumber Signature of Licensed Plumber
Master
City[Town ❑Journeyman License Number: S,5-0-/
APPROVED OFFICE USE ONLY
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SUB BSMT.
BASEMENT
1 FLOOR
2ND -FLOOR
-3
'FLOOR
-'4
'FLOOR
5 FLOOR
6m -FLOOR
7 FLOOR
8 FLOOR
Installing CompanyName:
��� / .�� ���
�`P�r+�
Check One Only Certificate #
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orporation T
Address:�2
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4l/ /3'
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CitylTown:
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State:
Zip Code:
❑ Partnership
Business Tel:
�1�J�' �TS
���Cell: 4�O�;a �� Fax: ��S"/7�S
❑ Firm/Company
Name of Licensed Plumber:
INSURANCE COVERAGE:
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes,LXj No ❑
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check 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 lumber Signature of Licensed Plumber
Master
City[Town ❑Journeyman License Number: S,5-0-/
APPROVED OFFICE USE ONLY
Toivn of Andover
Massachusetts
(Office Hozn s S: 00 A.117 to 10:00 AM)
Gas & Plumbing Fees
Effective March 12, 2003
❑ NEw: New Construction and Additions ❑ RENOVATION: Plumbing within the existing system
❑ REPLAcEi%,aNT: Removal and replacement of a fixture to the existing piping
`'ALL TENANT FIT -UPS ARE CONSIDERED "NE11,111
PLUMBING FEES
New Domestic Construction -- up to 3 Units
$1, 00 lus $5 per fixture
DNEW
New Domestic Construction — 4 waits or more
$200 plus $5 per fixture
DNEW
Renovation (Domestic)
$50 plus $5 per.fixture
DREN
Re lacement (Domestic) Existing Fixtures ONLY
$ f 0 plus $2 per fixture
DREP
Backflow Preventer (for boilers)
$10 plus $2 per fixture
DREP .
Bacicflow Preventer for irrigation systems)
$25.00
DBAK
New Commercial./ Industrial
$200 plus $5 per fixture
CNEW
Commercial — Renovation
$100 plus,$5 per fixture
CREN
Commercial Replacement — Existing Fixtures ONLY
$50 plus $5 per fixture
CREP
Backflow Preventer for boilers
$50 plus $5Per fixture
CREP
Backflow Preventer (for irrigation systems)
$25.00
CBAK
Re -inspection Fee 1$25.00
1
-INSP
GAS FEES
New Domestic Construction — up to 3 Units
$75 plus
$5 pera
Gas Stove/Heater
liance
DNEW
New Domestic Construction — 4 units or more
$150
plus $5
pera
liance
DNEW
Renovation(Domestic)
$50 plus
$5 pera
liance
DREN
Replacement (Domestic) Existing Appliances ONLu
$20 plus
$2 pera
liance
DREP
Gas Boller/ Furnace /Conversion Burner (Domestic)
$50 plus
$5 pera
liance
DREN
New Commercial /Industrial
$150
plus $5
per appliance
CNEW
Commercial — Renovation
$100
plus $5
pera
liance
CREN
Commercial Replacement — Existing Fixtures ONLY
$50 plus
$5 pera
liance
CREP
Gas Boiler/ Furnace / Conversion Burner (Commercial)
$100
plus $5
pera
liance
CREN
MISCELLANEOUS
Gas Lo /Fire Place
$50 plus $5 pera liance
DREN
Gas Stove/Heater
$50 plus'$5 pera liance
DREN
Utility / Bar Sinks
$10 plus $2 per fixture
DREP
Ca ed Sewer Lines
$25.00
SCAT
I Re -inspection Fee
$25.00
INS'P
;=:° Tliese fees are used if the permit is for this work only. If the permit includes other plumbing Avork, the
fee charged will be the fi.Yture fee which appears under renovation, replacement or new work ($2.00 or
$5.00)