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HomeMy WebLinkAboutMiscellaneous - 21 HIGH STREET 4/30/2018 (3)9053 NOR7q 04, ao ,x,10 0 A ,SSA NUSi Date .7- ;9g-/ /.. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that alG�... LCL/�f...1. !. :.. , .... , has permission to perform ...V 44- .. cc. ke" .Vrt-�L.f .... plumbing in the buildings of ............................ at.. .2-k. kA 16 (:1.. S i (-Le C. t........... , North Andover, Mass. Fee.c O.,�-O . Lic. No. A 5.-.1.�.2 . ......i . PLUMBING INSPECTOR'" Check # L_l MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: /V L q N WV i )p MA. Date: g� j�_ Permit# !3�'-dor 0 i rv5f Building Location: t' 5tOC wners Name: Type of Occupancy: Commercial ® Educational ❑ Industrial ❑ Institutional ❑ Residential[] New: ® Alteration: ❑ Renovation: o: 2 H Z Z LU z a pm w c�i Q [D m it w LEL 2 a H a D z O O L n Fa 2 te y LL Czi Y a F- w Q -SUB BSMT. BASEMENT 1ST F OOL R 2ND FL 00 R 3RD FLOOR 4T" F OOL R 5T" FLOOR R 5T" FLOOR R ,T" FLOOR FLOOR ent: LJ Plans Submitted: Yes ❑ No FIXTURES DEDICATED Ln 2 Z � z U N W C Val H z z D O [L I Fa - w O Ln z Ln In w Jhe Z ~ `�` z O = a Z Ln Ln y v H _z FW- � uL OI DEDICATED Ln � z N W C Val H z a 06 o 3 3 y Ln Q U' (9 C7 3I Installing Crrr,pany Name:._ TA -('14 < C ff/t/ .©t /t% Ch`'cl: One Only Certificate it Address: 7v f)d e 5 Yk City/Town: 4leA^State• EJ Corporation 1V Business Tel:(g'7 D) 4/ �3 ❑ Partnership '76 9 N Fax: , �Firm/Company Name of Licensed Plumber: j2 C N INSURANCE [5nva=once. 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Of No E]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 Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and acc nurate to the best of mplumbing work and i Knowledge and that all p!stallations 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 — %t J J Type of License: \L _ Title SI n ,O Plumber 9 atur Licensed Plumber "itylfown ❑ Master APPROVED (OFFICE USE ONLY) [Journeyman License Number: P Date..... `3..i'..././. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �j ............... ............................. has permission to perform .......... ..... w oz' ' wiring in the building of Y US ........ ... .. ............... at ..............�.......... �.C, q.....G....%.� ................ Orth Andover, Mass. d0 '/ el Fee.. z5............ Lic. No .............. ...................... ...................... ........ ELECMCAL INSPECTOR Check # ��� ,y Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Q — -T/ // City or Town of: NORTH ANDOVER 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) ;2-1/� (f , Owner or Tenant >3 e y o d%l/.S/ 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 ❑ „,New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters \Location and Nature of Proposed Electrical Work: Xecef S GOk 71/'O Completion of the ollowing table mav be waived bv the Inspector o 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 Above In- Swimming Pool rnd. [irnd. ❑ No—.of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons . ... KW No. of Self -Contained 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 Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent [OTHER: L Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (< (When required by municipal policy.) Work to Start: $%�� // In 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 OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: �O� 74 o,"-ezS � LIC. NO.: 9 Licensee: ­i'"a w► e Signature LIC. NO.: (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: Address: 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: 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 Owner/Agent Signature Telephone No. PERMIT FEE. $ Or, 15 1 f r IN 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): �D��r T�d� s Address: City/State/Zip: J I./ i 014h-o--7n-eel #: Are you an employer? Check the appropriate box: l . ❑ I am a employer with 4. ❑ I am a general contractor and I 7ployees (full and/or part-time).* have hired the sub -contractors '. I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their {. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their 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. #: Job Site Address: Expiration Date: 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 certify under the pains and penalties ofperjury that the information provide ove is true and correct. Sip -nature: v :i� Date. 7 -is ( �C/tl 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 #: -tocation,�?/� No. 9,01-,11 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ us Building/Frame Permit Fee $T -'4 / Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0///,' -q� l 246.1 �/ � Building Inspec,` CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 901-11 Date: January 5, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON _ 21 High Street, North Andover, MA 01845, BEYOND TRUST MAY BE OCCUPIED AS A BEAUTY SALON IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS -AS MAY APPLY. - Certificate Issued- to Pd-Fee: 100:00 - Receipt 4-24322 RCG Mills 21..High- Street. North -Andover-, MA -1-0845 Budding In ctor- October 3, 2011 Stantec Architecture Inc. 303 Congress Street, 6th Floor Boston MA 02210 Tel: (617) 423-4252 Fax. (617) 423-4333 Mr. Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Beyond Trust Tenant Fit -Out East Mills, North Andover Stantec Project 07804.20 Dear Mr. Brown: Beyond Trust tenant fit -out, located at 21 High Street on the fourth and fifth floors, at East Mills in North Andover, MA, was to the best of my knowledge, belief, and understanding constructed in conformance with the construction documents issued for building permit dated June 27, 2011, Permit # 901-11 in accordance with 780 CMR Commonwealth of Massachusetts building code. During the course of construction, representatives of our office made periodic visits to the site to observe the progress of the work. Respectfully, STANTEC ARCHITECTURE INC. i �"'_ 6 Linda Smiley Senior Associate Tel: 617-654-6003 Fax: Lin da.Smiley@stantec.com Attachment: c. David Steinbergh Kieran Whelan tss dowmenll