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HomeMy WebLinkAboutMiscellaneous - 224 SUMMER STREET 4/30/2018 j 224 SUMMER STREET 210/038.0-0172-0000.0 f t 9294 Date. 2. . . . . . . °TN TOWN OF NORTH ANDOVER �o PERMIT FOR PLUMBING ,SSACMUS� This certifies that ... . .G1. . .. . . . . ... . !'. . f .� has permission to perform . . fU/�16!7 o !'"`'--s . . . . . . . plumbing in the buildings of . . . . . i1-9a4 . . . . . . . . . . . . . . . . . . . . a. at . . . .Z. . ..�v/�? t". S7r ,�' , North Andover, Mass. Fee.90 .Lic. No../.3'�ar ,I.�iG .Z2.Hr-e%ar' 7 . . . . . . PLUMBING INSPECTOR Check # ��� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Al,.A'�tl1�l vti°�L MA DATE 113/--/'Z4 PERMIT 0 JOBSITE ADDRESS r22-gSom gq-e4 I OWNEWS NAME) OWNER ADDRESS TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL ( ( RESIDENTIAL` PRINT CLEARLY NEW: ( RENOVATION. REPLACEMENT:[. PLANS SUBMITTED: YES( I 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/OILISAND SYSTEM DEDICATED GREASE SYSTEM I I I I I L_ — DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOORIAREA RAIN INTERCEPTOR ORINERIOR I h --- f KITCHEN SINK • I 4 I - "�, j i 1 ! r I ,• LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK• l TOILET URINAL WASHING MACHINE CONNECTION t } WATER HEATER ALL TYPES. — - _ --- --- --- WATER PIPING OTHER f 6 I I t ! INSURANCE COVERAGE: �- I have a ctirrentliab- ikity ihsiiratice policy or its substantial equivalent which meets the requirements of MGL Ch.142. YE No ( I IF YOU CHECKED YES,PLEASE INDICATE THE PE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLIC OTHER TYPE OF INDEMNITY ( BOND OWNER'S INSURANCE:WAIVER:I oll aware that the licensee does not have the*insurance coverage required by Chapter'142 of the Massachusetts General Laws,and that 1ny signature on this permit application waives this requirei!.ilent. CHECK-ONE ONLY OWNER ( 'AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of time details and information I have subrnilted or entered regarding this application are true and accurate to tPff f my kngledge and that all Plumbing work and installations performed under the permit issued for this application Wil be Incompl':E(T1;cevq II Pe WW the Massachusetts Stale Plumbing Code and Chapter 142 of time General Laws. i PLUMBER'S S NAMQ LQj,jIC40X�,() j LICENSE 11 VV 4, I GNATURE � MPK JP� j CORPORATION ilii-Z PARTNERSHIP( �LLCI I1) I COMPANY NAME I ADDRESS(` j/�(/}G �9 CITY _ STATE�N"7 ZIP I TEL 33-2 800 2-01 FAX 8'&VD-I CELL 78Yyp I EMAIL ( UUi�,P-Y1GW �W�°rLt�'l,(� 'y? 1��r � / �O ` ROUGH PLUlMBINO INSUCTIONNOTE,S BELOW I'OR OFk']IiCET<7Sr':ONLY FINAL PUSPEC"IITION NOTES Yes No THIS APPLICATION'SMYES AS THE PERMIT ❑. ❑ FEE: $ PERMIT 9 PLAN REVIIZ (..NOTES s 1 3 'It'l�Coti�iiiitt!e«t1G o,�`lY�'iissfrclitts�(ts I)001111etitfi IgAtilddlAccidghts j D, Ieep 'ofiti►esfirtfials ' J g00 alftsltlttgfort�Yt�et ` tr; Mimi.,MA 021,11 � ' 1Vi(►it►.►tttrss];ov/rfr`tt ��t�i'ICCt+6�'�:tilitj1Ci15fEflOit•�t�$►;rt������i�fitl`ai►I:IItilcic• �. :, <t--. . , .... . t psfironfi�nrfols(IIlc�ir,�cin�isl,��iu►►l��eli�: ; 1l)#llfcttfti pilot+ittttlitSif, a :I'�.►'it1 LID, Pf ► I�1itt���l5utc�,c�4r�tiiratio>ttlicAitiidualy.: ,),(,� – t � c�cTeessc �GSC . �J f� 4 tx�l ctCe(�i i; �JC1/�7I1/� 1'ltoit (fr U 3, Q..u2..0 4 AtCj�o .titreirtjtlriyxrRCluccirttuepitiattlntc �,,� .I i 1 uo•• 7}nhbfprojt:et�tci�tiiteilj; ! ` !r1(d'[ttntttetnpt©}crtcitit„�_ rt.[[la►nngetternlcoitiracior�iurtl! } -• • t;nilr[okecs{fitltnttct�orpa[t-iuie};= hneettfrcdt)tcsntt�coritrttelors � dNeiECbiistriiction E 2,aT0111itsolaproprietororpagtter- listeclontTiet<ltacltetic�cef.= W- lCInotCcliitg i! shipatd'have[tocml}iopos TOSlib cattroe omli'm S Q--TWmoitlion i l orkhig foriuc fn pny cap qfy- cvoi-en.'comp.iasiaattce. it (]'ltuitriutgnrhti(ioas � [I�a.�eorl cts cgtng:Jnsurattce 5: tiYetrcc a co►poraMn and RT ti�itFnrF,] ofttcersltave.O cctsect(Iler* fQQ'rfeclricafte1ttirseridditioils. .�I.mm�lionieouuertloiiigaft ji otic cfglitofcgtaptiottperMOL 11111'ItimbIuqqptirsoradditiont 1tti,;elf:(NO Aorkera comp. ,[itrctteoEviteet}a _ 1243; correpato itisuranccregaired jt etliploj'ces.f Tlo[t'orl cisI f i 13,[)Othercoot .insurance jvillrcdj _ "'t),t}•Ultratth.F<ti;cfxt�a�C[t;ucslrlsafiitc•ettT.eittii�,�Uaott•ltwt�in�,ttt;irtnit;,r5 cain}a��ari0nroticy�t„ConuStiot tt;e,i��.itvsrs�ritaauimti[tlefsrOiAteillndir,.li,tgli:cprrede'nroHtt.pit:rnd[4entdndntstQtfutlraetuisuiaT;tsu$ititnfih�pftRT1411a41aXF12Such. tt\�fs:6i;trturCit:ckr8$llti\ftt+:lcGa:t;rdrnr:i3it�egitsr:tera6atri,i�gr1_ctuntr�+Cf'n�saiG•n�n]ra.t�+r,rrd[lcycritiE-ir's'e.+v�f..ifitrbifanualio,r_ JR/f�(rr(•Qr1I(ll�ix�rlfrvtls�,rvt'lrlit+�ra�arr<cars'cvi}l,.cjuscrlinul}}snrartrefdr/r{t'eiN�lvt'ees �?elc+},els/fir'E,dlfca'mlrFJoGslte;��"w � j �I�dP/1rrlt10lL _ lniturattccCongtany h'iuite; v� ��1 ((��QY7 .holicyslkorSe(fies Lic,/f: ' � - ? i d��l sGlwt�2a� ,— 3 JOb Silo A&,�55'• � � /L[tncirncopy bftic��ortset•c'congreiisirllmrl>blicystecltunEtonpage(sJtotti�ictgtit�YioTrc;<fiuiirt7eratttt�'i]tiln[IaniTzt[��� � ratlarc iasoGars'•t:6teittgens regnit`zct uncterSectiott�5/l ofivit3f;c.1-5�cnn dead fa the itiltoskiot>9rcrimitialpeart[ttcs:QCa , fiit�[rn to:S[,SQ¢.QO audloi oiteyear itnpriso mew,.as well as cIs it penartics In(116 fonts On STORWORK ORORR iiri;r;TM,, rilveseta}+rA rout the ola[o a t►dt�isc<t tlt tt recopy orlmss(alenrctif iutty be fons>arited(o ll►coffice or lttvestiga'lions.QfiheU rorittsumtic t`erageteriGca[iott. 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Please 1M iisatiouaTfiilxifttiaia Ieta1 = T�eckitt `f)telaotesiltRta lvt4. o�irsitaatidatmid,if ateGessat i supply sttb•contractor(s)italue(s),address(es)And pltonenuiitbca(s)Alot;with tlaeu ceriiticaie(s�pP Mkorance: Dintitedtiabilify Coanpataics(f:LC)or-Unitedf.iabjfitypaitiieiihips(LLP)hill[Ilo ellipipyqPs oflierfligli.filo litefiibers orparhiers;Areitot requiredto early ivorkets'coalipeitsationinsuranse. Ifao LLC oa:.LI,P sloes laava ::e4tpIoyees,apolicy is i-eattired.-M advised tliat ihls dffidavif stay be stibniitteci to the�Dep,•ufineait of Industrial Accidents forconfirntafi6ttof'mstttatteacoverage. AisbbesutetoBig"attd(late tilt nftdAvit Vie- tidavifshould be refurneti fo the city or town fltaf Elie application for the petutit or license is being requested,not the Deparhneuf of ' Fnttttstritil Accidents. Should you ­ airy nestrgns re-gardingdhc late 0r if ysit are required to•obfaii a workers' WQigeilOtionpolicy,pleasecallfile'D;,liattine re -numberfistedbalotu.'Velf-010 saif iosutanee license nuntberotLtheRppropriafcline. Cato or To }tit Officlais i i ,hcase bU&pure t}iitf the affdavitia coma)aletd tind.l rhitetT.legibiy 7lie bepatititenf lias Jarovideci a sl3;tce at Elis bottom j oftfie,'2fttdavif fory�oftto fill ouFin the eveitf fire Ofttcetif Investrgafions l►as fo cotifncf_ynur8g�rclutihe applicant. j Pleasebe sur@ to fill in(hope-nniftliceusentintb t tyliicli tyill.la�t[sed as a:referenee iiiinabzt:In addition,an applicant tlaafmustsubinitauulfi le ,nailt/icenseA P an lrcattotritt * .�la' PP 5 gi�eii3eat,aaee<l'onty sttlaniitone Aff_rdacafandic3tingcurrent JioIicylnforalation(ifnecessaty)andwider"job sireAddress,,tiaeapplicatit'shoulcttvrite"alllocafioitsln (cls+oi #otis)i)!'A cppy oftlic effidatii€tliatFias been offteiailystanaped ormarked by file 0111Y or€a�lni way be-provided to[lie Aliplicantasproofflaafavaficlaffidavitisolifilaforfutureperniitsoflicenses.Aaiety.Fiftidavitnausf6efitledonteacTa var.It'ltere a)tonic owner or citizen is titataiirmg.a)icettse 01-'P e Milt not related to anybus tress orconiniercial venture (k e.a dog;licettse or'perntitto burn leaves etc.)said person is Nornquired to complete tlils•affidavit. 'i'1iQ'[��T`ieeaflti��figations�i�oulttJikefo'tliatsl`)ro[tinadyrtncefort�oiu•co�fieiafioisacls>tdttTdS�ot�.faai'caiiygtiestioais, plow-do not hesita'ta to,give tts#scall: Tttc bzparfaiignt'sactdsess,teleplaanenud fax nttnalie'r fie Cotxttnoa�sE�e��f11 p�?'1'��s��ltt�se€Is • f D61iaclitient of IndusEuttl ACCI&IttS ' office of Itaveiigtfolt _ 600ZVashitlgtiyti St�et;t ,Boston,MON 1.1 Tol.0617.727-4pp0 e9E4.06,of 1-877 TVIASSAPp, l lei:%iseil�2G•iss l�f��;�6I�'�7�`1�77�9 �tni��:iTtass,got�/clt�